refugee health: While asylum seekers in Leicester were battling with language barriers and ignorance of the NHS, healthcare workers were struggling to understand their needs and rights.The resulting frustration was resolved through open discussion. Helen

Published: 21/03/2002, Volume II2, No. 5797 Page 26 27

Health workers are not always aware of asylum seekers' needs or the experiences that have brought them to the UK. In Leicester we have found workshops an effective way to educate our staff about these clients' needs.

Hearing their individual stories has increased staff understanding.

About 1,000 asylum seekers are living in the city, dispersed throughout several districts. They have come from more than 40 countries. They are placed in hotels, where they receive full board, or in self-catering accommodation. Those in self-catering receive weekly vouchers for£36,£10 in cash, and those in hotels receive£10 in cash.

Under the Immigration and Asylum Act 1999, the home secretary assumed responsibility for the support and accommodation of any asylum seeker who would otherwise be destitute. The National Asylum Support Service carries out this role.

In 2000, the government decided to disperse asylum seekers away from south-east England to reduce pressure on local authorities.

People were sent to accommodation within designated cluster areas in various parts of the UK.

They were given no choice about where they were sent. Leicester was nominated as a cluster area and local agencies began to work out the likely demands on local services.

Leicestershire health authority allocated a GP to every asylum seeker. Only a few GPs were involved, because of where the asylum seekers had been placed. The increased workload led GPs to feel pressure on services to their existing registered patients. Eastern Leicester primary care trust addressed this by setting up an asylum seekers' nursing service in February last year. One full-time nurse was recruited and this year two part-time nurses were added.

The service helps asylum seekers register with a GP and gain access to other forms of healthcare. It liaises with all staff in contact with asylum seekers.

The nurses carry out initial health checks in the hotels and explain how to access the NHS.

The nurses use Language Line, the telephone interpreting service, which guarantees to find a translator for any language within 90 seconds.

Asylum seekers are often unfamiliar with common UK illnesses, so colds and flu come as a shock.

The nurses have produced a leaflet about the NHS, including information about how to access GPs, dentists and pharmacists, translated into 13 languages. It has been distributed to asylum seekers and housing providers.

But soon it emerged that health service staff were experiencing difficulty in providing care for asylum seekers. Staff were unclear about their clients' rights to healthcare, resulting in a loss of confidence. For example, they did not understand the differences between asylum seekers and refugees. Staff who were keen to help were often unsure what to do and worried that their approach to these patients might be inappropriate. Asylum seeker and refugee patients sometimes felt they were not being treated as individuals or that GPs did not listen to them.

The number of health staff in contact with asylum seekers also increased, to a level where the specialist nurse could not deal with all queries.

So we arranged three workshops in order to explain the system, point out the rights and entitlements of asylum seekers, highlight the role of Language Line - which offers telephone translation in 148 languages - and detail the real-life experiences of asylum seekers.

The workshops used an inter-agency partnership model created by Leicester health action zone, and were run by professionals and refugees.We thought this would promote understanding and reduce stereotypes. Refugee Action, Leicestershire HA, and the specialist nurses and refugees themselves came together to plan, deliver and evaluate the three pilot workshops. The HAZ education and training co-ordinator acted as a link between the various parties.

Two men who had just completed the asylum process and gained refugee status were recruited to help the workshops. Najibullah is a teacher from Afghanistan and Hamid a radiographer from Iran.

Both had arrived in the UK by lorry and each had paid a 'people trafficker' about£8,000. They had accessed the asylum system via Refugee Action.

Though both are professionally qualified, neither had been able as yet to get jobs in the UK. But they were confident and willing to work alongside us in this initiative.We paid them£40 each.

As asylum seekers' first contact with the NHS is likely to be through primary care, we sent flyers about the workshops to GPs, practice managers and health visitors. Each workshop had 17 places, and they were oversubscribed twofold.

The sessions lasted for two-and-a-half hours.

Participants were given an information pack, then a speaker from Refugee Action described the process of seeking asylum. The refugee speakers described their journey to Britain and their perception of the NHS. Their powerful first-hand accounts were the central plank of the workshops.

To promote frank discussion, participants were invited to write down questions that were then put to the speakers anonymously.

These questions included, 'Why didn't you seek help from your embassy when you arrived in this country?', 'Why did you leave your country?', and 'Have you encountered any racism?' The speakers responded openly, which helped dispel many misconceptions.

The specialist nurse described her responsibilities and role in explaining the NHS to asylum seekers, many of whom are unfamiliar with GPs and expect to go to hospital and be seen immediately. The session ended with an explanation of Language Line.

The workshops were evaluated.Most participants felt that what they had learned would help them in their work. The highlight had been the chance to discuss with refugees.

Some participants said they would like to know more about the asylum system and the needs of children. Some asked to hear from women refugees.

While the evaluation forms focused on the knowledge gained and what information was the most useful, the change in some people's attitudes - from being fairly negative to having more empathy - could not be measured so exactly. But the success of the workshop could be seen from comments such as, 'I was very interested and impressed by the enthusiasm of the staff involved and touched by the personal experiences of Hamid and Najibullah.'

All the people involved commented on how the sessions had dispelled myths promulgated by the media.Hamid and Najibullah felt that the staff who attended 'changed their mind about us and we now have friends that are trying to help us'.

It was the first time Hamid and Najibullah had spoken publicly in the UK, and despite both being a little nervous their confidence grew through the sessions.The talk raised issues about understanding different cultures and awareness of the potential for misunderstandings on both sides. Indeed, both sides had positive personal feedback after the sessions. Each side welcomed being able to talk independently and freely.

We now plan to hold a workshop every month and hope to reach all agencies coming into contact with refugees and asylum seekers in the voluntary and public sectors.

We believe this format would be easily transferable and could help other marginalised groups to access services.

Helen Rhodes is specialist nurse for asylum seekers and refugees, Eastern Leicester primary care trust.

Rachel Munton is senior education co-ordinator, Leicestershire health action zone.

Key points

Many NHS staff are unsure about the rights of asylum seekers and refugees to healthcare.

Asylum seekers and refugees have little knowledge of the NHS.

lWorkshops including refugee speakers helped dispel misconceptions and were highly rated by primary care staff.

The format is very transferable.