Monday 16 March 2020 was to be my last ‘normal’ day working as a refugee health nurse practitioner. My team leader asked me to go to a large hospital the following morning to see what they did in the COVID testing clinic, then come back to start up a testing clinic in our not-for-profit health service.
The next day, a general practitioner, registered nurse and I gathered around a mobile phone in our carpark to review a YouTube clip on how to do a nasal swab. It had been a long time since any of us had done one! My journey through this ‘once in a century pandemic’ had begun.
Early in the testing rollout, it was apparent that some vulnerable groups were missing out, not attending clinics, even though the rates of COVID were increasing. Notably, there were low numbers of people with refugee or asylum seeker backgrounds.
Refugees from Myanmar, predominantly ethnic Karen from the Thai border area and Chin from the area bordering Bangladesh and India, form the largest refugee communities in the eastern region of Melbourne. People who are refugees or asylum seekers are not migrants: they do not choose to come to Australia. Rather, they accept settlement here, having fled their country of origin—like Myanmar—to avoid persecution. They are unable to return to their countries of origin because of well-founded fears for their safety. People of the Karen and Chin communities—like all refugees—have usually undergone traumatic experiences, often torture, during their journeys to Australia. These journeys may take a year or two or even take decades.
Our refugee health program has built strong relationships with the Chin and Karen communities since it began in 2009. This is a result of its model of care: most newly arrived refugees are referred to us as their first point of contact with the healthcare system. Each new arrival is offered a comprehensive nursing assessment and then referred to appropriate internal or external services including a general practitioner, who is frequently located at our refugee health clinic. We maintain ongoing contact through a refugee-specific medical clinic, annual flu vaccination clinics, a women’s health clinic, health education sessions, and liaison with bicultural workers who are community members.
We reached out to the community to find out why attendance numbers at the COVID testing clinic were low. Community leaders told us that people felt ‘guilty’: people knew if they had symptoms, they might pass on COVID, so it was better not to know. Others did not know where to go or had difficulty getting to clinics. Some simply did not want to go to an unfamiliar site that they did not trust.
In response to these concerns, we began a mobile testing service with its first fit-for-purpose bus. It offered services to groups at known venues, such as churches, community centres and a Hindu temple, at times that suited the communities.
The first clinic was held outside a Chin Haka church which has more than 1,500 members. It was a freezing day in June 2020. I rode in the passenger seat next to the bus driver, one of our managers who had never driven a large twenty-seater bus before. She did brilliantly! The registered nurse sat in the back surrounded by the necessary equipment—from laptops to yellow bins to fold-up tables—all restrained to prevent pieces becoming flying objects in transit. We met a community leader and two interpreters who spoke Chin Haka, a dialect of the Chin languages. They helped in our work, as well as supporting the many community members who arrived by car and on foot.
My first patients smiled shyly, and I recognised the mother and her three primary school children despite the surgical masks they wore, because I’d provided their initial healthcare a few years before. We were all uncertain about the testing process adapted for this outreach setting. Our first step—registration—was completed by a staff member in full PPE seated at the rear of the bus. Community members, appropriately distanced, filed past her giving their details through the open back window.
As it turned out, the process went smoothly. With the aid of the interpreter, I asked the assessment questions and wrote the pathology form for the nurse who performed the test. People were patient and happy to be at their familiar church with people they knew well—although the youngest child jumped up and down holding his nose after the swab! At the close of the clinic that day, we had provided almost one hundred tests.
The trust the communities had in our health service proved vital for my second pandemic role, commencing early 2021—clinical lead for the vaccination program. Outreach services were again integral to improving community access, along with other vaccination sites such as a council building, a basketball stadium and a sports pavilion.
We again worked closely with refugee community leaders and services to provide appropriate information and negotiate suitable sites for their communities. I found myself in the bus again, travelling to clinics in churches, community centres, homeless shelters, supported accommodation and caravan parks. My personal favourite was vaccinating homeless people at the open-air bar of the motel in which they were housed. My patients and I faced each other on bar stools, equipment ready on the nearby bar table.
Again, early attendance numbers for vaccinations were low. But eventually the clinics were ‘sold out’: word of mouth about positive experiences helped reduce hesitancy and improve confidence in having the vaccine. At the program’s conclusion, ninety per cent of the Karen and Chin communities in the eastern suburbs were double vaccinated.
The pandemic years tested us, our services and nurses across the state. But we found ways to adapt and continue to care for those from refugee and other communities because we met them where they lived.