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Brisbane GP Dr Rebecca Farley loves her jobs.

Yes, she has a few. Clinical Lead in Refugee Health for both Brisbane North Primary Health Network and the Mater Refugee Health Service, Deputy Director of Clinical Training at Princess Alexandra Hospital, and more recently she has become Acting Chair of the RACGP Specific Interests – Refugee Health network. She is also a mum of two.

Life is busy and messy but if you ask, Rebecca will happily tell you—she wouldn’t have it any other way.

“I work with amazing, dedicated people in an area of medicine I am passionate about and I am raising my family—I feel very lucky,” she says.

Rebecca became a Fellow in 2011 after undertaking her AGPT Program General Pathway training with GPTQ.

It was an academic research post GPTQ helped to facilitate during her training that provided her first real exposure to the primary care networks which have been developed in Queensland for refugees and asylum seekers.

“The research post introduced me to some wonderful GPs who mentored me and enabled me to develop my interest in this area – they helped me to understand how refugee healthcare is delivered in Australia,” Rebecca explains.

Inspired in particular by the work being done at Inala Primary Care, the not-for-profit practice where she undertook her final registrar training placement, Rebecca began making plans to carve out a career in the field.

“There are so many challenges that refugees and asylum seekers face being in a new country, it is essential that they have access to the kind of comprehensive care GPs can provide,” she says.

“I knew I wanted to be doing all I could to make sure that access – and the service – are there for them.”

 

Rebecca’s working week

Currently Rebecca’s work life revolves around a flexible three-to-four day working week that comprises clinical work, along with education, management, research and advocacy.

The bulk of her clinical work happens at the Mater Refugee Complex Care Clinic (MRCCC), which is part of Mater Refugee Health.

Established in 2002, the MRCCC is a predominantly Mater funded service supported by GPs, many of whom volunteer their time – usually one session per week – outside of their mainstream work.

A clinic day for Rebecca begins with a group practice management meeting.

The clinic’s doctors (a team of GPs supported by a paediatrician and psychiatrist), nurses, allied health professionals and administrative staff take a hands-on, collaborative approach to clinical governance of the service.

Rebecca explains that this weekly meeting provides an opportunity to review and assess new referrals received from general practices and community services, discuss and case manage more complex cases and address issues that may have emerged since the last meeting—these can range from IT system issues to changes in government policy likely to affect the clinic’s patient cohort.

“We are always looking at our processes and trying to ensure that everything is working as well as it can be,” she says.

“It is important that we are aware of policy changes and the potential impact of these changes on refugees and asylum seekers in our community so that we can facilitate the most appropriate access to services and minimise any potential barriers.”

The clinic opens to patients at 9am, offering long appointments to all to ensure the ‘complexity’ in cases is appropriately catered for – accredited interpreting services are a key part of many consultations due to language barriers.

“The clinic is structured to cater to the specific needs of our patient cohort,” Rebecca explains.

“All too often we see process embedded in our broader healthcare system that make it difficult for patients to access the services we provide,” she says.

“For example, receiving an appointment letter written in English that requires a response creates a real barrier for patients who may not be able to read or speak English.

“To mitigate these and other problems we have things in place such as reminder phone calls with interpreters the day before an appointment and our appointment times are scheduled with a flexibility that allows patients time for travel and to plan for care of young children or other family members.”

On a clinic day Rebecca will see up to 10 patients.

“These are complex cases, and not just in terms of medical complexity,” she explains.

“One of the challenges we face is bridging cultural gaps in the healthcare systems—many patients have had limited access to healthcare and in particular preventative healthcare overseas, so understanding and navigating our healthcare system can be incredibly difficult for them. Part of what we are doing in a consultation is building a patient’s health literacy,” she says.

Trauma is a significant issue also.

“Many patients have experienced trauma leaving their home countries, living in refugee camps and traveling to Australia,” Rebecca says.

“Taking a gradual, person-centred and trauma-informed approach is really important to being able to build trusting relationships with patients that will allow us to provide them with high quality care.”

 

The power of human connection

Rebecca recognises the power of human connection as a guiding force in the work she does each day.

“Over time I have done a lot of training in cultural sensitivity, which of course has been very valuable for deepening my understanding of working with people from different cultural backgrounds to my own,” she says.

“Ultimately, though I think as individuals we are all so very different—when I am sitting across from a patient I’m going to try to respond to them in that moment and look and listen for their specific cues about how they are feeling and what they might need from me. One thing I have learned over time is that you can’t make any fast assumptions.”

Time, Rebecca says, is one of the most powerful things she can offer her patients.

“By that I mean time to listen and to really try to understand what is happening for them,” she explains.

“It is critical that consultations are not rushed and that if things aren’t going well—if the patient is uncomfortable or seems distressed, we stop, reflect and adjust our approach,” she says.

“The collaboration between doctor, interpreter and often a member of the clinic’s nursing staff in a consultation is critical to a consultation achieving what it needs to for a patient.”

 

Supporting patients in a range of ways

One of the biggest challenges Rebecca faces as a doctor working with these vulnerable groups of patients is that often their health issues are compounded by the stresses they are facing on every other front.

“Ongoing legal issues and uncertainty around visa status, finding long-term accommodation, employment worries—all of this with the trauma that is brought about through fear for and separation from family and friends, these are the things I sometimes feel helpless to address,” she says.

In those moments, she says it helps to recalibrate.

“I try to return to knowing that our willingness as healthcare providers to assist patients as they navigate these challenges in whatever way we can is important and valuable,” she says.

“What is helpful for me too is having the opportunity to help address some of these problems out of the clinic setting by working with government and other organisations at a more systemic level.”

 

Making strides through clinical governance and advocacy

Rebecca notes that Queensland is “doing a lot of good things” to achieve networks of co-ordinated healthcare and other key services that support refugees and asylum seekers.

“Collaboration with the State Government has been integral in fostering this during the past decade,” she says.

In 2017 Refugee Health and Wellbeing: A policy and action plan was developed for the state, a move Rebecca feels was key to achieving some of the positive changes we have seen in the care of refugees and asylum seekers in Queensland.

One of the action plan’s outcomes was the development and launch of the Refugee Health Network Queensland.

The Network, which is funded by the State Government and supported by Mater, aims to build capacity and partnerships and facilitate the coordination of care across health, settlement agencies, communities, government and non-government sectors.

“These networks are now active in Brisbane and throughout Queensland, helping us to become more aware of need and coordinate services in response,” Rebecca says.

“I think we have come a long way towards creating sustainable change for refugee communities.”

On a day-to-day basis Rebecca says her role in advocacy often comes down to building awareness.

“We are working to make sure GPs everywhere are aware of the resources that are available to support them in caring for refugees and asylum seekers,” she says.

“Having conversations with leaders in our refugee communities and connecting people with services is one of the most effective ways we can do this.”

As Acting Chair of RACGP Specific Interests – Refugee Health network Rebecca now has the opportunity to further pursue policy-related issues at a national level.

The RACGP Specific Interests recognises that many GPs develop interest in niche areas of General Practice throughout their career and values these specific skills and experience through the endorsed groups of RACGP Specific Interests.

“This initiative [the Specific Interest – Refugee Health network] provides a platform for GPs throughout Australia who are working in this space to come together and share their experiences and expertise,” she says.

“Together we get to explore ways to collaborate on education, research and advocacy.”