Ripple effects: integrating international medical graduates from refugee backgrounds into the health system in Australia

The field of ‘refugee health’ is generally understood in terms of the efforts of health professionals from a host country to provide care for humanitarian entrants. This paper attempts to undermine that idea, focusing instead on the service that health workers from refugee background communities are able to render, both to their own communities and to broader society, when barriers to their participation are made more equitable. The point of departure for this Practice paper is the 2019 pilot ‘Observership Program’ that was initiated by Mater Refugee Health in Brisbane, Australia. This was in response to, and in collaboration with, international medical graduates from refugee backgrounds. The two doctors who advocated for the programme had already independently embarked on a series of advocacy initiatives aimed at facilitating health workforce participation for members of their communities. In what follows we: outline the barriers to their medical registration and employment in Queensland, Australia; describe the process of setting up a 9-month clinical observership for two participants; and we reflect on the implications of the programme from a health policy and systems perspective. Ultimately, our contention is that because health systems are complex and adaptive, increased health workforce participation by members of marginalised communities has the potential to change the culture of the health system, making it more adept and responsive. Such, we propose, are the ‘ripple effects’ of addressing the obstacles to health workforce participation by members of refugee background communities.

[1]  S. Bell,et al.  The case for refugee physicians: Forced migration of International Medical Graduates in the 21st century. , 2021, Social science & medicine.

[2]  Bryan Mukandi Being Seen by the Doctor: A Meditation on Power, Institutional Racism, and Medical Ethics , 2021, Journal of Bioethical Inquiry.

[3]  Charles V. Taylor,et al.  Gadamer on the Human Sciences , 2002, The Cambridge Companion to Gadamer.

[4]  R. Sidhu,et al.  Navigating the Politics and Ethics of Hospitality: Inclusive Practice with Forced Migrants , 2020, The British Journal of Social Work.

[5]  Janet Stajic … but what about the Aboriginal and/or Torres Strait Islander Health Worker academic? Transcending the role of ‘unknowing assistant’ in health care and research through higher education: a personal journey , 2020, The Australian Journal of Indigenous Education.

[6]  L. Young,et al.  To stay or go? Unpacking the decision-making process and coping strategies of International Medical Graduates practising in rural, remote, and regional Queensland, Australia , 2020, PloS one.

[7]  Z. Jakab,et al.  Refugee and migrant health in the COVID-19 response , 2020, The Lancet.

[8]  Audrey Lumley-Sapanski The Survival Job Trap: Explaining Refugee Employment Outcomes in Chicago and the Contributing Factors , 2019 .

[9]  A. Scott,et al.  Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence , 2019, Human Resources for Health.

[10]  Bryan Mukandi The North African Syndrome: Traversing the Distance to the Cultural “Other” , 2019, The Bloomsbury Companion to Philosophy of Psychiatry.

[11]  V. Pascoe Australia’s Toxic Medical Culture , 2018 .

[12]  D. Pittet,et al.  Migrant and refugee populations: a public health and policy perspective on a continuing global crisis , 2018, Antimicrobial Resistance & Infection Control.

[13]  J. Horncastle,et al.  Practicing care: queer vulnerability in the hospital , 2018 .

[14]  M. Hynie The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review , 2018, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[15]  M. Guillemin,et al.  The right doctor for the job: How international medical graduates negotiate pathways to employment in Australia , 2018 .

[16]  Bryan Mukandi South-South Dialogue: In Search of Humanity , 2017, The Australian Journal of Indigenous Education.

[17]  R. Spaaij,et al.  Settlement and Employment experiences of South Sudanese people from refugee backgrounds in Melbourne, Australia , 2016 .

[18]  Aileen M. Moreton-Robinson The White Possessive: Property, Power, and Indigenous Sovereignty , 2015 .

[19]  S. Duckett The need for a regulatory rethink: a perspective from Australia , 2014, Future Hospital Journal.

[20]  S. Behrman Accidents, Agency and Asylum: Constructing the Refugee Subject , 2014 .

[21]  Ramotse Saunders,et al.  A Roadmap for Observership Programs in Psychiatry for International Medical Graduates , 2012, Academic Psychiatry.

[22]  K. Pottie,et al.  Migration and health in Canada: health in the global village , 2011, Canadian Medical Association Journal.

[23]  Peter S Hill,et al.  Understanding global health governance as a complex adaptive system , 2011, Global public health.

[24]  Nora Segar,et al.  Barriers to Health Care Access among Refugee Asylum Seekers , 2011, Journal of health care for the poor and underserved.

[25]  H. Kum,et al.  ‘When They don’t Use it They will Lose it’: Professionals, Deprofessionalization and Reprofessionalization: the Case of Refugee Teachers in Scotland , 2010 .

[26]  B. Burton Surgeon sentenced to seven years in jail for patient deaths , 2010, BMJ : British Medical Journal.

[27]  Gloria Dall'Alba,et al.  Learning to be professionals , 2009 .

[28]  Lisa Anteby-Yemini Peau noire, masques blancs , 2008 .

[29]  Leda M. Pérez,et al.  Community health workers: social justice and policy advocates for community health and well-being. , 2008, American journal of public health.

[30]  T. Faunce,et al.  A Critical Analysis of Overseas-Trained Doctor ('OTD') Factors in the Bundaberg Base Hospital Surgical Inquiry , 2006 .

[31]  H. Joseph Wen,et al.  Health care and services delivery systems as complex adaptive systems , 2005, CACM.

[32]  S. Skull,et al.  Hurdles to health: immigrant and refugee health care in Australia. , 2005, Australian health review : a publication of the Australian Hospital Association.

[33]  N. Khanlou,et al.  Intersectionalities of influence: researching the health of immigrant and refugee women. , 2004, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[34]  R. Gottlieb,et al.  Alienation and Freedom , 2003 .

[35]  A. Stein,et al.  The mental health of refugee children , 2002, Archives of disease in childhood.

[36]  H. Krahn,et al.  Educated and underemployed: Refugee integration into the Canadian labour market , 2000 .

[37]  J. Oppong,et al.  The refugee crisis in Africa and implications for health and disease: a political ecology approach. , 1998, Social science & medicine.

[38]  M. Muecke,et al.  New paradigms for refugee health problems. , 1992, Social science & medicine.

[39]  María Lugones Playfulness, “World”-Travelling, and Loving Perception , 1987, Hypatia.

[40]  Peter Singer,et al.  Famine, Affluence and Morality , 1986, Global Justice.

[41]  F. Fanon L'An V de la révolution algérienne , 1966 .

[42]  John McLeay,et al.  THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA , 1965 .