A safe environment

For the doctors and practice staff at the Family Medical Practice in Mount Druitt, it’s not unusual to see ‘consultations’ in the waiting room, in the corridors, or at the front desk.

“We often have people coming to the practice with their electricity bill, asking what’s that?” says Dr Ziad Fashka.

Dr Ziad explains that all of the doctors and staff in the centre speak Arabic, and for refugees, the medical centre is a safe and warm environment to ask health-related questions, as well as questions related to the education system, English courses, housing, employment, et cetera.

“Usually dealing with organisations is a cold experience – when they go to Centrelink, for instance, they fret about it, they don’t know what to say and they see different people each time. But dealing with our medical centre is a warm experience – they know the staff and the doctors and we have a friendly environment.”

The medical practice has become something of “hub” for refugees and patients who come from an Arabic speaking background. Dr Ziad says this transition happened quite organically, as local community groups, churches and individuals – many of whom were moved by the stories they read about people escaping a war-torn Syria – came to the medical practice looking for ways they could help.

“For example, people from the local driving school came to our practice and have offered to give driving lessons to refugees at a reduced fee.”

He said other groups have advertised jobs for Syrian refugees at the practice, while some offer English lessons.

“The local refugee centre actually visited our practice and they now refer refugees to our practice,” he added.

At least half of Australia’s intake of 12,000 Syrian and Iraqi refugees have been settled in western Sydney and Dr Fashka says his practice’s patient load has grown accordingly. Currently, about 20% of their patient base are refugees.

Dr Ziad says he finds many refugees go through a ‘honeymoon’ period when they first arrive, which is replaced by feelings of frustration and angst as they try to understand and navigate the Australian way of life.

“When they first come here, they are safe, they are happy, they have successfully moved to Australia, and they have wonderful, romantic notions of their new world. But after that, once they settle, they start to experience the everyday difficulties.”

He is familiar with this transition, having immigrated to Australia himself in 1996. Dr Ziad graduated from medical school in 1991 in Syria, and after coming to Australia, he finished his AMC Exams in 1999, then went on to complete his internship and residency at Nepean Hospital. In 2002, he joined the GP Training program in Newcastle. He returned to Sydney in 2005 and established the Family Medical Practice in Mount Druitt with Dr Adib Obeid and Dr Therese Kanaan.

The experiences of refugees prior to arriving in Australia can have long-term effects on their physical and mental health. For refugees who have fled persecution, they may have suffered trauma as a result of war and conflict. Prolonged time spent in refugee camps with limited access to healthcare and proper nutrition can also have health-related consequences. And even after arriving in Australia, many can find their new environment stressful as they try to navigate a completely new country, with different systems and processes than what they are used to.

Dr Fashka says many of the health problems experienced by refugees are similar to those of his Australian patients. The biggest difference is that his refugee patients have a much higher incidence of mental illness.

“What is prominent in this demographic is post-traumatic stress disorder,” he says.

“Most of these people they are exposed to some sort of violence, if not directly to themselves, they have witnessed some form of violence or they have heard about violence or stories of war, persecution, torture. So there is a lot of post-traumatic stress disorder, especially in children. And in adults, we see depression and anxiety, and post-traumatic stress disorder.”

The Family Medical Practice in Mount Druitt also employs a psychologist and a social worker to help patients experiencing mental health issues.

His advice for other medical practitioners who may be dealing with refugee patients is to find subtle ways of discussing mental health.

“A lot of patients are embarrassed to speak about it and mask it, so the doctors need to dig for it or encourage them in a subtle way. Let the refugees open up about their traumatic experiences and mental issues that they might have.”