Meeting the health needs of humanitarian refugees
At the close of 2020, 26 million refugees had been forcibly displaced from their homes. The physical, emotional, financial and mental hardships endured by many refugees carry significant short-term health consequences. What is less well understood are the long-term health impacts of refugee status, and whether these are driven by pre-migration experiences, the resettlement process, or post-migration life.
Dr Areni Altun is an osteopath who is undertaking her PhD with our Department of General Practice. Her project explores the role of culture in shaping the experiences and coping mechanisms of persistent pain in minority populations, and will provide greater insight into the delivery of culturally component care by healthcare providers.
Dr Altun recently published a paper in BMC Public Health, detailing her findings around refugee experiences of chronic pain. Chronic pain – or pain recurring or lasting for more than three months – has rapidly risen to become the leading cause of long-term disability globally. It is sometimes triggered by a single identifiable injury or event, but many cases are precipitated by a sequence of smaller events, or may not have an identifiable cause.
Previous studies have shown that marginalized groups including women, socioeconomically deprived people and people with lower levels of education, are more likely to experience chronic pain, and to face doubt and inadequate care when seeking help.
Dr Altun says, “Many women who migrate to Australia have been subjected to multiple traumas and as a result, chronic pain is a frequently exhibited health condition – between 66 and 98 per cent of traumatized people.
“The time following migration is also recognised as a time of crisis, stress and adjustment and resettlement concerns such as housing, employment, and financial stress, can compound issues by creating psychological distress.
“I want to help healthcare professionals deliver care in a culturally appropriate way that acknowledges the social and psychological contexts of these women’s lives.”
Building a New Life in Australia: The Longitudinal Study of Humanitarian Migrants is a major longitudinal study that examines how humanitarian migrants settle into a new life in Australia. Run by the Commonwealth government, five waves of data is available to researchers.
Dr Altun examined the data for self-reported chronic pain and long-term disability among participants, as reflected in two questions asked across the various data collection waves.
310 women met the criteria and were included in her analysis. The majority were born in North Africa or the Middle East (54 per cent) and over a quarter had never attended school. Eighty-eight per cent reported exposure to one or more traumatic events such as violence, imprisonment, extreme living conditions and conflict.
Since arriving in Australia, the majority had found stable housing. However, 99 per cent were unemployed, with 42 per cent reporting stress caused by not having work, language barriers, loneliness and discrimination. Twenty-five percent reported poor to very poor general health.
The analysis showed that pre-migration factors, but more importantly post-migration factors, are associated with self-reported chronic pain and long-term disability in refugee women.
Post migration experiences such as general health, discrimination and region of settlement were most likely to be associated with chronic pain, with women settled outside metropolitan areas at greater risk. The rates of poorer general health also appear to be greater in the initial years of resettlement in Australia. This suggests that there may be many unmet health needs that are compounded by the challenges of resettlement, and could be addressed by migrant health services.
Dr Altun says, “Regional and rural Australians across the board have long been known to face shorter life spans and generally poorer health outcomes than Australians in metropolitan areas, in large part driven by reduced access to healthcare. This is amplified for these women, who already have a history of trauma.”
The post-migration factor that was most significantly associated with reporting chronic pain in the study was stress arising from discrimination.
Consistent with previous findings, pre-migration factors such as age was a risk factor for chronic pain among the cohort. The researchers also found that migration pathway may also be an important flag for doctors, indicating potential chronic pain. Women who migrated under the 204 Women at Risk visa category had greater odds of reporting chronic pain those in other visa subclasses. This suggests these women are uniquely vulnerable to gender-related human rights in addition to sufferings often experienced by other refugees.
Nearly two thirds of the women who reported chronic pain also experienced a long-term disability, injury or health condition. However, the percentage of women who had a disability identified at arrival was 37 per cent, whilst five years into resettlement this figure dropped to 13 per cent. It’s unclear what caused the change, but severity of tissue injury does not appear to be a good indicator of future disability. It raises the notion that better initial pain control may reduce long-term disability, and work to break fear-avoidance patterns and pessimism around pain.
Dr Altun says, “These women have often been through incredible hardship before arriving here. I’m grateful that my research has been able to uncover new opportunities to better support them in their new lives.”
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