13 March 2019

Refugee health compromised by locked away records

Government TheHill

Health information collected from refugees on their way into Australia, including history of infectious diseases, is being effectively lost because of the partitioning of records between two federal departments.

Paediatrician Dr Georgia Paxton, who leads the Royal Children’s hospital immigrant health service in Melbourne, said once a refugee was in Australia, their medical care becomes the responsibility of the Department of Social Services.

However the results of their often extensive offshore health screening were retained by the Department of Home Affairs. Access to these records relied on knowing an identification number, as the database was not searchable by name.

The local doctor is not made privy to this identification number and has to rely on the patient remembering it from their initial consult, which is unlikely, Dr Paxton told delegates at the Royal College of Pathology Australasia’s conference last month.

If the doctor wants to find the identification number, they must first call the settlement coordinator of the patient, who will then contact their case manager. The case manager has to find the social services number for the patient in question before consulting with Home Affairs to find the original immigration number.

“The chances of that happening in your average… primary care consultation is absolutely zero,” said Dr Paxton.

The system for refugee health screening was split under the Abbott government in 2017, when Home Affairs absorbed all offshore medical care, while follow-up in Australia became the responsibility of the Department of Social Services.

In a paper from 2017, Dr Paxton and her colleagues recommended to the federal government all refugees, including children, should be offered a tailored health assessment within the first month of arrival in Australia.

This would ideally follow on from the patient’s pre-departure screening in the country of origin, where applicable, or screening in offshore detention. For children, this offshore testing includes a chest X-ray, latent TB screening, HIV serology, and a urine dipstick.

But currently, much of this  “phenomenal” public health information about the patient’s history often continued to sit in the offshore screening database.

“We have very sophisticated offshore health records but at the moment the practical ways to get that offshore information is difficult,” Dr Paxton said.

She was hopeful that new technology would help the offshore and onshore health systems communicate better.

“I think it will evolve over the next few years, particularly as the data systems change,” she said.

Dr Paxton also told the conference vaccination rates among refugees were alarmingly low. Less than 3% of Syrian and Iraqi refugee children attending language school in Australia were up to date with vaccinations. And none of the adults in the same cohort were up to date for their age group, despite having been in Australia for many years.

Dr Georgia Paxton has provided advice to the Department of Immigration and Border Protection but does not currently hold any advisory roles with the Australian Government.