24 September 2020

Providing purpose-driven care for refugees and asylum seekers in Melbourne’s west.

By Utopia Health Director Dr Lester Mascarenhas with input from Practice Manager Peita. 

Utopia Health is a new service designed to meet the needs of the refugee and asylum seeker community in Melbourne’s west. Up to 30 per cent of residents in the Wyndham local government area were born overseas and a significant proportion of these people came to Australia as refugees. We spoke to Utopia Health Director and GP Dr Lester Mascarenhas and Practice Manager Peita about the process of setting up this unique practice.

Dr Lester Mascarenhas:

“Over the past 12 years that I have worked in the western suburbs of Melbourne it occurred to me that whilst there were plenty of excellent services providing social, welfare and allied health services for refugees and asylum seekers, there were no dedicated primary care medical services with the specific skill set to serve these communities.”

Starting in 2016, Dr Mascarenhas led a comprehensive consultation with refugees in the Wyndham area. The Utopia Health team primarily engaged with refugee communities born in Burma such as the Karen, the Karenni and the Chin people. The team also reached out to community leaders in the Tibetan and Ethiopian communities.

A women’s health discussion group at Utopia Health.

The following themes emerged from engagement with the community:

  • Interpreter use was limited in mainstream general practice
  • Appointment times were short
  • Mental health issues were rife in the community and these were not being addressed
  • Alcohol and other drugs were a serious problem with the youth
  • Local, timely and culturally appropriate access to treatment for blood borne viruses (in particular viral hepatitis) was difficult
  • Refugee communities wanted a clinic they could call “their own”

The above issues underpinned the foundation of the Utopia Refugee and Asylum Seeker Health Service.

A tailor-made service

Utopia Health opened in January 2020 with Dr Mascarenhas as Director, who said:

“Utopia is a new service. It is one of the first of its kind in the western suburbs of Melbourne. I enjoy working here immensely. Our team is passionate, driven by purpose and understands the importance of listening to the communities that we serve.

We take a holistic approach to health care, which starts at reception. We have bicultural Karen and Karenni workers at reception for our communities and this makes them feel that Utopia is a safe and happy place with friendly staff that have time to listen to them in their own language. We always use interpreters.”

Karen bicultural workers at Utopia Health.

Early in 2020 Utopia established links with specialists to provide a sustainable and local service for local communities. As a result of this engagement Utopia offers a range of niche specialist services. Each service is run collaboratively with nurses and GPs, which makes the most of the specialists’ time and increases participation, involvement and job satisfaction for nurses and GPs.

The range of services offered includes:

  • Mantoux testing (tuberculin testing) for new arrivals under the age of five and for asylum seekers who do not have access to a Medicare-funded QuantiFERON
  • GP-led latent TB treatment for adults with access to specialist advice when needed
  • An infectious disease and liver clinic service that is GP-led, supported by specialists and offers assessment and treatment for hepatitis B and C along with access to FibroScan technology
  • A joint paediatrics clinic with Werribee Mercy Hospital, with a focus on developmental disorders
  • A dermatology video-health service with Sinclair Dermatology
  • Care for refugee and asylum seeker patients with complex post-traumatic stress disorder, provided in partnership with Alison Mynard (a psychologist from Next Door Psychology) and Foundation House.

Life after COVID-19

Utopia Health had been open for barely three months when COVID-19 hit the local area. Impoverished and non-English speaking communities were among the hardest hit.

Dr Mascarenhas: “Two of our GPs joined the effort to assist with primary care and assessment of COVID-19 positive patients at the public housing towers in North Melbourne and Flemington during the two weeks of police-enforced pandemic restrictions. It was a steep learning curve!

“During my work in the towers, close to 100 per cent of the patients that I assessed face-to-face were COVID-19 positive. We learned how to use PPE well and how to assess COVID-19 positive people in the community, and about the importance of social and welfare interventions to assist in reducing the spread of the virus.”

Utopia Health did not receive any funds for COVID-19 testing, but in response to an overwhelming demand from patients, the team began COVID-19 testing in their car park. Utopia is also in discussions with Wyndham Council and Wyndham Cultural Centre to set up a pathway to assess COVID-19 positive members of the refugee and asylum seeker community.

Dr Mascarenhas: “I believe the community trusts us to look after their best interests and see us as the clinic for their community. Costs have been kept down by employing and collaborating with people and organisations who share our values. We embraced the COVID-19 challenge and realised that unless we continue to build our skills, we will not meet the needs of our communities who are badly affected by COVID-19.”

To learn more about Utopia Refugee and Asylum Seeker Health visit their website.

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