sMater - Refugee health | Dr Rebecca Farley

As part of Refugee Week, Clinical Director of Mater Refugee Complex Care Clinic Dr Rebecca Farley joins sMater to delve into the complex nature of refugee health, from how to treat new arrivals to the importance of creating a safe and trusted space for patients and their families.

GP Education activity log: 

- Podcast title - sMater: Refugee health
- Provider - Mater Misericordiae Ltd 
- Date published – 13 June 2025

- Certificate of completion - https://www.mater.org.au/Mater/media/sMater-Certificates/sMater-Certificate-of-Participation-Refugee-Health.pdf

Recommended resources for further reading:

https://refugeehealthguide.org.au/

https://www.refugeehealthnetworkqld.org.au/

https://www.mater.org.au/health/services/refugee-health

#refugeehealth #refugeeweek #smater #mater

To learn more about Mater, visit https://www.mater.org.au/

Transcript

Hello and welcome to this episode of SMater, a podcast by clinicians for clinicians

brought to you by Mater, an Australian leader in health care for more than a

century. My name is Jillian Whiting and I'm your host, coming to you from Meaghan,

the land on which this podcast is being reported. And I'm Dr Maria Boulton, GP

Specialist and former President of AMA Queensland. Today we're joined by Dr Rebecca

Farley, Clinical Director, senior medical officer and GP with Mater Refugee and

Multicultural Health in Brisbane. We are Mater. We are Mater. We are Mater.

This is SMater.

Rebecca, welcome to SMater. Thank you for having me. It's a pleasure to be here.

Rebecca, we acknowledge that this is a very big and complex issue. So I think it's

important to start by setting the scene. What does refugee health embody? I think

it's a great question. I've thought about this a lot over time and I think I've

been working in this space for about 15, 20 years now and I think it's become more

and more nuanced over time. I think at the end of the day what really embodies

actually is something that we're trying to achieve across healthcare more broadly.

It's about really being able to create those safe, culturally responsive, trauma

-informed healthcare environments, equitable healthcare environments for all of our

patients so that we can then really recognise and respond to the needs of

individuals within those environments. So I think to think about refugee healthcare

specifically, we're talking about people who have had a forced migration journey of

some kind And I think for all patients, it's important for us to understand the

journey, but in refugee health care, I guess there's the commonalities that we see

in forced migration, but then each individual still has a really unique story.

So I guess to speak to those commonalities, you know, we do, we're caring for

people who have had to flee their homes, they've often experienced conflict,

trauma or trauma, sometimes torture, they've been separated from their families,

their loved ones, dislocated from their communities, their culture, their homes.

So I think it's recognising those commonalities and responding to all of those things

that we see, the things that people might have been exposed to. It's a personal

issue for you, isn't it, Maria? Yes, I was born overseas and I came to Australia

on their humanitarian visa when I was 13 and certainly I grew up in El Salvador

and El Salvador is so different to Australia and as a teenager it was quite a

journey, a different health system, different education system, I'd never seen a train

for example, I'd never seen a building taller than 18 stories, huge and you know

ramifications and finding navigating the health system here too because over there

it's quite different. It was a huge learning experience and certainly my heart goes

out to any teenager who's in that position and their parents of course but yeah I

was wondering I mean not everyone discloses that they may be a refugee. How do you

identify those people You may not disclose that they're a refugee so that you can

provide the appropriate healthcare for them. And thank you, Maria. I think, I mean,

the story you just shared in some ways really speaks to that in many ways. People

don't necessarily, you know, people come from different, along different pathways.

People don't necessarily come through our humanitarian program with a certain visa.

We'll see people who have travelled to Australia, sometimes on spousal visas,

orphans, we see sometimes people who have come on student visas or tourist visas and

then applied for protection here in Australia. So it's not it's not easy and I

think I often I often speak to colleagues who say you know refugee health that's

not really a big part of my practice at all I don't know that I'm seeing anybody

who's got a refugee journey and when you start to speak to them actually they

really really do when it's actually a big part of their practice. And so I guess I

would say, really, it's more broadly thinking about how does the impact of forced

migration impact your patient population more broadly? I think the other really

important thing to think about is that it's not just about the initial resettlement

period. So sometimes people will or may not want to define themselves by this

experience. I think we're all like that. We don't want to be necessarily defined

forever by an experience, but the refugee experience makes up someone's part of some

story. So that can impact people both right throughout their lives.

It can impact across generations. So we need to be thinking really broadly about how

forced migration might be impacting our or not. They might be a second generation,

you know, that are still being impacted by some of the factors that we're talking

to. Why is it really important in your mind to identify whether someone is a

refugee or an asylum seeker? When I think about people seeking asylum in Australia,

I think about really people who are in that process of applying for protection here

in Australia. They're simply still in that process. So the majority of people will

be found to have a well -founded fear and will ultimately be given protection here

in Australia. But the fact that that process of applying for protection can be

incredibly protected and so what that means in terms of people's, you know, we know

the impacts on mental health of that prolonged, you know, application process.

So that has to shape our care. We also know that people seeking asylum, and often

people are seeking asylum for over a decade. It can be a really, really prolonged

journey. People may have been in detention.

And so, and in that time, in our community, if you have a protection visa, you can

access Centrelink, you can access English classes, your kids can go to school, all

of those sorts of things. If you're seeking asylum, if you're seeking protection, all

of a sudden, all of those things kind of just go way. So we have patients, and

that's really the patients we're caring for here, that I'm caring for here at the

Mater are patients that have unstable access to Medicare, so often people can't

access basic healthcare. They may not be able to access, well they can't access

Centrelink, may not have work rights, are really limited in terms of financial

resources, access to food and housing, can't access NDIS, so being able to understand

that and what that means in terms of the patients' needs and what we can offer is

really important. And I guess I would just say as well, like I think sometimes

people ask me about what I do and they sort of, they're like, "Oh, that's really

interesting. I didn't know that we had that number of people seeking protection

living in Brisbane." You know, so like the latest data, and again, this will be an

underestimates that is that we've got about 900 people seeking protection in

Queensland.

And largely living in Brisbane, Goodner, Gatton, if switch to Womba and we're seeing

all of those patients here at the Mata So I think just it can be a group of

people that are really sort of not seen in our community and really vulnerable

Speaking with you and and doing this podcast really opens up our minds when it

comes to this complex area But I was just wondering and it is something that gets

touched in our GP training briefly. It's such a complex area.

I was just wondering, are you aware of perhaps any funding that GPs and our teams

can access to upskill in this area? Yeah, it would be wonderful. I mean,

at times there have been little pockets of funding through PHNs and those sorts of

things to do quality improvement activities. The primary healthcare networks have a

multicultural health framework And so I'm really working on implementing that at the

moment. So that's been wonderful. But I think-- but no, I guess is the very,

very simple answer at the moment. But at the same time-- so another role that I

have is as chair of the migrant refugee and asylum -seeker health specific interest

group with the College of GPs. So certainly we do a lot of work around developing

resources, guidelines, professional development activities for GPs,

and I work with a lot of nurses who do the same through the Refugee Nurses of

Australia. So I think knowing that those resources are available, that they can make

up part of your professional development as a health professional is important as

well and is valuable as well.

Australia has a long -standing tradition of humanitarian resettlement, having provided

safety to nearly one million individuals since World War II. In the 2023 -2024

period, the Australian Red Cross reported that Australia granted 20 ,000 refugee and

humanitarian visas, with the majority of recipients hailing from Iraq, Myanmar,

Afghanistan and Syria.

So for a newly arrived refugee or asylum seeker walks through the door, what makes

up the essential components of that initial health assessment?

So effectively I guess there's a lot of evidence to support you know that really we

talk about sort of comprehensive patient -centered catch -up care in the early

resettlement period and so essentially that health assessment really comes down to a

really comprehensive history physical

examination, there's investigations that we recommend screening guidelines to inform the

kind of things that we should be thinking about, and then developing a management

plan. And that really considers obviously all of the things that the patient may

have been concerned about or presented with, anything that may have emerged from kind

of recommended screening should the patient have wanted to take that up, and then

things like catch -up immunisations, those sorts of things as well. So yeah, I think

it really guides that preventative health care that we would offer somebody who might

have experienced a refugee journey, and I think to build on what I was saying

before, I mean, that health assessment is really a clinical guideline. There are

Medicare rebates, so that fits under the health assessment item numbers that there

Medicare rebates for if somebody is accessing that in the first 12 months after

arrival and have Medicare. But I would say so many of my patients don't have

Medicare, it doesn't mean that I don't offer them the same care that's recommended

in those guidelines and I might be seeing someone seven, ten years down the track

and if it's the first time that I'm seeing them I will still go back to those

guidelines and make sure all of those elements have have been touched on or off it,

I think is a really big thing and it's amazing how often something, I mean that

early resettlement period is there's so much going on, there are so many competing

priorities, it's amazing how much something might have been missed. Medicare card is

really key, isn't it? Particularly SAGP when you're trying to work out perhaps what

bloods to order and understanding how much they cost and whether or not you do need

them. But I was just wondering are there any particular conditions that affect

specific refugee groups and how can we as a GP practice team address them in a

culturally sensitive way? Yes absolutely as is true for all of us depending on you

know the nation population that we're a part of there will be specific things that

are more prevalent for you know women of a certain age or you know and we we need

to be thinking about those things. So we do, again, I've spoken about that journey,

so because of reasons of perhaps physical injuries during fleeing a conflict,

the mental health implications of a prolonged sort of journey and the trauma that

might be involved in that. Because of the geographic locations people may have moved

through, we'll see exposure to different infectious diseases. We certainly see

nutritional deficiencies, people have experienced food insecurity and I guess also we

see a lot of delayed presentations of whether it be malignancies or chronic disease

because people haven't been able to access preventative health care. So absolutely, I

think the really common things we talk to really probably are, we talk to infectious

diseases, we see higher rates of strong alloys, it's just a myosas hepatitis and

those things are dependent really on the journeys again. We do see higher rates of

mental health concerns and PTSD in particular.

We do see nutritional deficiencies, iron deficiency, vitamin D deficiency, B12

deficiency and again you'll see all of these things kind of really outlined in those

recommendations around that health assessment and catch -up care and more physical

injuries, and as I said, delayed presentations of a lot of other conditions. And I

guess what I would say that was really important is that patients will still come,

as we all do, with their concerns. And the most important thing is to be able to

respond to those concerns in that initial phase, rather than being like, I'm thinking

about all these other things. And I think the other, you know, when you talk to

responding in a way that's culturally responsive. I mean, you can't have these

conversations without working with an interpreter. If the patient doesn't speak

English, you need to access an interpreter and work with them. I think often we can

kind of fall into the trap of sort of saying, oh, this is what we have to offer

and just almost assuming that this is the way it will be done. So being able to

recognise the importance of really working with your patient and being able to

explain why we offer these different things and preventive healthcare is an

interesting concept and it's not universally available to people so being able to

explore that with people. And I think the other thing that I'm really careful to do

is as much as possible kind of normalise this. So I'll talk about the fact that

yes we see a lot of strung alloys, it's really prevalent in Papua New Guinea,

actually really prevalent in all the parts of Australia too. So this is something

that we think about for patients who have lived in Australia as well. We're offering

these catch up immunisations. These are the same immunisations that my child had, so

being able to normalise that as much as possible and being really careful, sometimes

I think it can feel quite othering to say your population experience.

It's just about tailoring that message to the individual. Can you expand on why it's

important to work with a trained interpreter rather than perhaps using a family

member or a partner to interpret it? Absolutely. I mean I think there's some

beautiful research and I might share this as well from a GP in Canberra, Christine

Phillips, looking at some of the negative outcomes when you don't work with a

professionally trained interpreter. It's an incredibly difficult job and I think I've

become more and more aware of that over time and the interpreters that we work with

are incredibly skilled.

I guess the expertise involved in being able to take sometimes these concepts,

sometimes something that we might explain in a few words will take a few minutes to

for an interpreter to be able to explain and to be able to share that message. And

I think when you're working really collaboratively as two professionals, you can

really develop that shared understanding and make sure that the communication is

clear. So there's a kind of professional expertise and skill that we're being working

when we're working with interpreters. I think the other issue is obviously when

you're working with family or friends, I remember really clearly one of the examples

in that research that I was speaking to, somebody, a parent who is presenting and

needs to talk about their experience of trauma or you know,

a sensitive issue that they want to talk about, pregnancy or, you know, a women's

health issue. And then we use their child to interpret for them. No parent is going

to say what they need to say when it's their child who has been asked to interpret

and the harm that we can cause in doing that is profound. And so we really need

to be incredibly careful with, with, obviously with children, but friends and family

as well just don't necessarily have the skill, the expertise to be able to interpret

the way that we need. And also we'll sometimes try and protect their friends and

their family as well, so there's other factors at play. Rebecca, you spoke about

there is so much going on for people when they arrive. It is such a busy time and

also mentioned PTSD and mental health issues. Those migration and social issues for

seeing people like that, refugee patients, how can they be addressed and any other

advice you can give around that? I mean, I think the conversation around those

mental health implications I think is big and we can certainly talk about that a

little bit more. I think in terms of some of the other social factors that are

impacting on our patients, I think, again, we're pretty used as health professionals

to thinking about what's going on outside our consultation rooms and for patients who

have recently arrived as, you know, as refugees, there's so much going on.

And so I think those conflicting priorities are not even knowing really what, you

know, what you should be doing, what's most important. We're recommending that people,

you know, get to TAFE and go to English classes, they're trying to enroll the

children in school, you know, trying to find housing. Often people have really

unstable housing, so all of those factors are really significant and that's all on

the background of often having friends, family, loved ones who are overseas and are

unsafe. So if we're trying to, you know, pursue our refugee health assessment and

we're offering, you know, survival screening, Often that can be really out of touch

with the reality of what somebody is living through. So I think being really mindful

of those things and adapting your care accordingly and just being responsive to the

needs of the patient and what's a priority for the patient at the time and just

recognising that there are so many services available to support you in that.

So often we'll be working really closely with settlement settlement services, we're

quite closely with TAFES and to try and you know make sure that people are able to

get to where they need to be. Absolutely schools having children in schools so

important so really working closely with those those other organisations I think is

probably the main thing. Vaccination is a priority in refugee health and often you'll

get people who come from overseas who may not have medical records or vaccination

records or if they do they may be in a different language. How do you support this

community when it comes to increasing and supporting the vaccinations? I think

probably one of the first things to actually remind ourselves of when we can think

about that is actually there's lots of of us as health professionals that don't

recognize that everybody who's come to Australia's refugee or seeking asylum is

eligible for government funded catch -up vaccinations, so I think that's the first

thing. And I think then also talking to the fact that things that we've already

spoken to, actually recognising when somebody might be eligible. So, so many people

that we're just actually not offering catch -up vaccinations to.

I think the second thing, again, is then to be mindful of just how, again,

you know, people have not always had positive experiences with healthcare overseas

we're not you know I think we we know we're doing our best we want to do good we

should be trusted but that's not always been the case for for people through their

journey so being able to to really sensitively talk to patients about why we offer

these vaccines or what they are you know what's what what what are we offering with

these vaccinations what are some of the adverse effects that they need to be mindful

of, all of those things that we do for everybody. But doing it in that really

culturally responsive way, really watching for those signs in the individual that

they're not understanding, that they're disagreeing that this doesn't make sense,

making sure that you've engaged with a professional interpreter is really important.

So all of those things, I guess, are part of it. I think, as you said, We don't

always have records of what may have been offered overseas. So again, there's really

beautiful guidelines around this. Our nursing team here at the Mata has some

beautiful resources on the Refugee Health Network Queensland website. If we don't have

records, we do recommend offering a full catch -up schedule. Basically, that will be

basically so that you've been offered the same immunisations that someone of your age

would have been offered in Australia.

obviously that is informed by your your medical history so if you do have records

that's wonderful if we can get those records translated that's wonderful and that

will inform what we offer but we we wouldn't routinely be doing a whole bunch of

serology. What signs of trauma should our team be aware of and how can we help

people through it through trauma -informed care? To the context of refugee health

care, I guess, more specifically, we're really aware through that migration journey

that almost without exception our patients have experienced trauma and so just being

aware of that is actually the first step of being sensitive to that, is the first

step. We don't recommend necessarily that you would ask someone in detail about their

trauma experience and I think really recognising the potential to do harm if you

don't have the time, the space, the expertise, the skill to be doing that is

important. But at the same time, not being aware or sensitive to the potential

impacts is equally potentially calming. So I think often in that early resettlement

period, we're just sensitive to the fact that this might be impacting people's

concentration, their memory. You'll see those little things in getting you know more

and more kind of agitated or anxious or perhaps withdrawn kind of just going

somewhere else and I think being really sensitive to all of those things in that

that early resettlement period is important and kind of enough and then over time I

think you do you start to see here more and more of you know my my experiences

around somatization headaches chest pain some of the regional pain syndromes that we

see which are really complex to manage and I think again just to know that there

are services available to support patients we in Queensland again very lucky to have

the Queensland Programme of Assistance for Survivors of Torture and Trauma which

offers specialised counselling. But again you know patients again how you discuss that

and whether that's something that people want to access is a really big question. It

is a lot and I think sometimes as clinicians we think we somehow need to jump in

and help and fix things and find solutions but actually that trust and rapport that

we build just by being there in those early consultations I think is really

important and I guess I'm saying that because I think it can be really difficult

for clinicians to, I think we get fearful that we need to do more, that we need

to know more, that we need to do something And so if you can create a safe space,

that's a huge thing. And then as time goes on, when you've been sensitive to all

that along the way, then you get to the stage where someone says, you know, I

actually experienced these symptoms and they seem to be related to this other,

these thoughts and at the same time these experiences. And you start to be able to

have those really meaningful conversations where you can start to really offer people

the care that they need and the treatment that they need. If we talk more about

the environment itself and the consulting rooms, and how do you make that a safe

and trusted place for these particular patients? Yeah, I mean, I think you hear...

I think all of those things that you hear are so true. I mean, so thinking about,

you know, the artwork that you have on your walls and the images that you have on

your walls and making sure that you don't have a lot of information in a language

that people won't necessarily understand. All of those things are important. Having a

calm space is important. I'm really, I can think of recently a woman,

she was from Papua New Guinea, looked at some of the brochures that we had on the

wall. We have guides in different languages about the healthcare system and she sort

of said to me, "Oh,

that that person's wearing the traditional dress that we wear, those things are

lovely and they're really important. But I actually think beyond that,

actually what's most important is the way that everybody in your practice responds

when someone walks into the clinic. It's the warmth and the welcome that people feel

when they come into a clinic. Any other particular resources that you wanted to

mention or that you think it'd be helpful for the health care teams more broadly?

Yeah, gosh, so many reasons. I think probably the really big ones to know about as

clinicians is certainly that refugee health guide. So that was developed in

collaboration between the Australasian Society of Infectious Diseases and the Refugee

Health Network of Australia and it's a really comprehensive guide, not just to the

management of infectious conditions, but broadly to refugee health. And it speaks

beautifully to some of the mental health factors that we've discussed today. But in

Queensland, we're really lucky. We have the refugee health network of Queensland who

also have a beautiful website, and you'll just find a wealth of resources there. So

there are resources around how do you create-- absolutely, a guide to how do you

make your practice welcoming to somebody from a refugee background? How do you access

interpreters? What resources are available? Lots of patient information in language,

education, you know, that sort of thing. If you're really interested, we do that

network as an e -news, so you can sign up for the e -news. And we do, we often,

we run education and, you know, at the quarterly, basically we run education

sessions, So they're all available online as well, and we'd love to see people in

person as well.

- Mater Refugee in Multicultural Health is a national leader in delivering care for

multicultural communities. In the 2023 -2024 financial year, it provided culturally

appropriate care to 1 ,768 patients, many with complex healthcare needs.

The long -serving Mater Refugee Complex Care Clinic, which is the only Queensland

Health Mudder GP medical service for people without Medicare seeking asylum, saw 470

of those patients across GP, psychiatric and paediatric services.

What services are available at the Mudder and who can access them and how do we

refer to them?

Our Al -Jahim in the Mater Multicultural and Refugee Health Department. We have

several clinical services, so we have the Mater Refugee Complex Care Clinic, which is

a service specifically for people seeking protection who may not have access to

Medicare, so we provide a general practice service for those patients. We also have

the Multicultural Health Coordination Program, which is a service delivered by nurses

and social workers, who basically their role is to help coordinate care for people

from a multicultural background so it's a broader service and liaise really closely

with GPs in the community and then the hospital system. We also have the Mater

Refugee, sorry Mater Integrated Refugee Health Service, again a nurse -led service that

is really there to support patients in that early resettlement period so that's

caring for patients who have come through the humanitarian program and the nursing

team will really look at providing an initial nursing assessment and then work

collaboratively with GPs in the community to provide that medical component of that

assessment as well. We've also got a paediatrician and a psychiatrist that work in

the service one day a week and so again Basically, you can access our website and

there's referral forms for all of those different services and I think,

again, more broadly, there are, you know, we do, in maternity, we've got a refugee

health specific service, again, we work really closely with infectious diseases,

cardiology, I think a lot of the other specialties within the Mater Hospital who we

would refer to as we would, you know for any patient. What services are available

for asylum seekers and refugees who live outside of Brisbane? I think that's a

really challenging question. So as I said we do and this is not ideal.

We're really the only funded service to see people seeking asylum who might not have

access to Medicare. So we here in South East Brisbane will see patients from Tuoma,

from Ifswitch, from Gatton, from Goodner, which is obviously not ideal in terms of

their transport needs. And we do what we can to make sure that is as patient

-centred as possible and we use telehealth where we can. But that is a very real

gap, I think, in the services that are available in Queensland. And it's only been

relatively recently that the service here has been funded to see people without

Medicare, so it is a significant issue. I think I would say as well,

the Mater Hospice is the refugee health network of Queensland and part of that team

is a refugee health fellow, so a GP again with a wealth of expertise and experience

in this space who is there to support clinicians across the state.

So, we certainly see GPs around the state offering pro bono care.

In terms of accessing hospitals and any hospital based service,

basically Queensland Health since 2017 has had a health directive that says that

people who are seeking asylum without Medicare can access services at no cost to

themselves. So people absolutely can still access care in our Queensland Health

services. And again, we also have some of the urgent care clinics have also made

themselves available to see patients without Medicare. So there are options, but

they're certainly not ideal when you can't access. I think general practice is such

a key and component of our health care system if you can't access that, that's a

real challenge and I think a real challenge is also sometimes hospitals and health

services around the state aren't necessarily aware of the Queensland Health Directive

so we're so used to asking for a Medicare card and when someone says that they

don't have one immediately saying well you can't access the service so really

ensuring that people know that patients seeking Islam are eligible for care is really

important. - So there seems to be a lot of need to expand these services,

essentially. And I was just wondering what the role of advocacy is in ensuring that

this happens.

- I mean, to be honest, I think the space that I'm working in with people who

haven't got access to Medicare and are seeking Islam, that's because there was a

gap, there was a gap here in Brisbane as well, we knew that there were patients

who just simply couldn't access care. And so there's been a lot of advocacy for a

long time, I think, to address those gaps. In a speech of 2017 in the introduction

of that Queensland Health Directive, meaning that people could access care in

hospitals before that, we absolutely saw patients presenting with, you know, with the

Schemic heart disease and being turned away and there were some very prominent cases

there, or being seen and then chased to pay bills that they simply couldn't pay and

then the mental health impacts of that. So in 2017 in Queensland the First Policy

and Action Plan for Refugee Health was launched and having worked before and after

that, I think it's been very clear to me how important that advocacy was and having

that clarity in terms of policy and and priorities in Queensland Health has been in

terms of actually you know shaping what can be offered you know what is resourced

and bringing together what is sometimes really disparate services in the past so I

think that advocacy has been incredibly important and I something I mean I think

Marie on your earlier question we're not done. There are you know so many people

settled in regional parts of Australia who still haven't got adequate access to care

and so it's really it's an ongoing journey. What does the future hold do you think

in this area of healthcare Rebecca? I know but I would love it. What would you

love to happen? What do you think is important to happen? I think I mean I think

as a clinician working day to day, the first thing that I would hope is that we

all develop the skills and the knowledge and the experience to be able to deliver

that culturally responsive trauma -informed care to all of our patients and to be

able to recognise those that might have had a forced migration journey or might be

being impacted by a forced migration journey. So be able to do that well and be

able to do that across all of our different health care services. But I think,

you know, I have been really fortunate in my career to be able to work with people

working at that policy and advocacy kind of space. And I think,

as I've said, we've seen incredible changes in Queensland that have absolutely shaped

the care that we're able to offer. And I think, you know, recently we've really

been able to see that in response to the pandemic, in response to emerging

humanitarian crises overseas, we were able to really quickly mobilise access to care

for people coming from Ukraine. At the moment, we can access care for people coming

from Gaza. We can do all of those things. But before we had those systems in

place, we simply couldn't. And so I think really one of the biggest challenges for

the whole sector now is that we still see a lack of coordinated integrated policy

at a federal level, if that makes sense, and that's why we're seeing these real

gaps in general practice. So I think a real focus for us as a sector is really

about how do we start to ensure that at a federal level health is involved in

those conversations so that we can meet the needs of the communities that we are

welcoming into our country. - As I said at the beginning, this is a very big and

very complex issue. - It is very big and complex. That may have been too big and

complex. - And congratulations on the work that you do to Rebecca. Thank you so much

for joining us today. But before we go, we just wanted to introduce you to a

little segment that we call the Checkup.

So we have a deck of five cards with five very random questions aimed at giving us

an site into you, so it's meant to be a fast five. Are you ready? Sure. OK.

Rebecca, if you could impart one piece of knowledge on a medical student, what would

it be? Probably actually a question around culturally responsive care, actually,

probably. People often ask me about what does that mean, and how do you develop

your skills in that space? And I think probably it's about-- I you know,

those medical students to be mindful of, you know, their journey and what's shaped

them and how they've kind of lived and moved and walked through the world and where

they sometimes might not be seeing the bias or the prejudice that they might hold.

And I think when you can really start to lean into those conversations with your

patients, understand their perspective, understand that it may be very different to

yours, but there's so much to learn from that. And really, I think that has really

shaped my care over years and it's the thing that actually brings me the most joy

being able to bridge those cultural differences and find a shared understanding.

- Who do you admire? - I guess I've been thinking about this conversation so I might

just say that I really admire. I mean, I have the most incredible team all working

in really different professional roles where from different cultural backgrounds we

have a really diverse team. And, you know, when you think about this conversation,

just to think about how everybody's been able to come together to make great changes

and deliver really good care.

What was your first concert? First concert? Oh my gosh. I love a festival.

I love a festival. So I'm sure I was at some form of music festival.

There would have been camping involved and probably some folk sort of, maybe Missy

Higgins with some bare feet, I don't know, something like that. And if you weren't

doing this, what would you be doing? I think working with people from different

backgrounds to my own and learning how to do that well and being able to support

people at a time when they are really quite vulnerable in our community, it's just

been an absolute joy, so I haven't thought hard about what I also might be doing,

I'd love to be an artist or something, but I feel like I haven't put the work in

there.

And final question, if a genie could grant you one wish, what would it be? Working

towards sustainable solutions to some of the conflicts that we're seeing and being

able to, as a society, certainly at least here in Australia, we are incredibly

privileged and we're really fortunate positions which will be able to to really

welcome and and and appropriately support the people arriving here into our country

and to be able to recognise just how much we or you'll have to learn from each

other and how much richer that makes our society I think I'd love that. I feel

like I get to experience that in my work day to day it's it's it's pretty it's

pretty magnificent thing actually. It is thank you so much for joining us and

sharing your experience with us today on SMater. My pleasure, thank you both. For

our listeners at home or in the car or having a well -deserved break between

patients, thanks for tuning in. See you next time on SMater.