Policy differentiation in CALD women's health

Ms Voula Messimeri-Kiandis, Deputy Chairperson of the Ethnic Communities' Council of Victoria and Executive Officer of the Australian Greek Welfare Society spoke at the Year two Annual Forum about the case for Policy differentiation in CALD Women's Health.

A copy of Ms Messimeri-Kiandis' speech is detailed below.

Firstly I would like to thank the organisers of this forum for the prominence given this year to CALD women's health and well-being. This is a very important indicator that there is a strong will to address the needs of this numerically strong and diverse group of women in our community. I do hope that our deliberations here today will contribute towards the formulation of policies and programs that will seek to better the lives of CALD women.

I will start by quoting Eva Cox who would not be a stranger to most:

"Social Capital, she states, refers to the processes between people which establish network norms, social trust and facilitate co-ordination and co-operation for mutual benefit. She adds that social capital should be the pre-eminent and most valued form by any capital as it provides the basis on which we build a truly civil society. Without our social bases we cannot be fully human. Social capital is as vital as language for human society."

I have spent the last 20 years engaging in the development of networks for marginalised and disadvantaged groups. Attending to connect isolated people to others with whom they may have an affinity in terms of culture, ethnicity, gender and age.

Eva Cox resonates very strongly with my own belief that individuals can most effectively create change and build social capital when working through groups, networks and associations.

My presentation today will seek to place CALD women's health and wellbeing within the context of the need to invest in the building of social capital and to re-energise the community development model as a way of achieving lasting health benefits for newly arrived as well as established CALD women.

So who are CALD women and what are some of the health and well being concerns that are seen as priority by women themselves and the organisations that they have set up to represent them?

Close to a quarter of Victoria's population was born overseas, while 43.5% of Victorians were either born overseas or have a parent who was born overseas. Victorians come from 233 countries, speak over 180 languages and dialects and follow 116 religious faiths. CALD women in Victoria comprise 19% of the total female population in Victoria.

The majority of people have settled in Melbourne across all the Metropolitan areas and smaller but significant groups also settling in rural Victoria. It may sound superfluous but I would like to emphasize that CALD women are not a homogenous group. They, we are, at different stages of settlement within Australia and residency can range between the most recently arrived to women who have migrated to Australian 30-50 years ago.

Some CALD women are still battling to establish their legal status within Australia. While others have been in Australia for so long that they gave birth to their children here and are now grandmothers, not withstanding the fact that they may still struggle to put a few words of English together.

It would make sense then that responses to the health and well being of CALD women need to take into consideration the stage of settlement and the immediacy for basic essentials such as housing, income support, employment and training, and access to education for children if one is looking at women who are new to Australia. I will pick up on larger established CALD women later. The Victorian Immigration and Refugee Women's Coalition held a New Migrant Women speak-out in February 2004.

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The following highlights the gaps identified by women at the speak-out in relation to health and wellbeing:

• Health professionals lacked skills and sensitivity to specific cultural differences particularly knowledge of health practices of some ethnic groups.
• That there was a shortage of counselling services for refugee women.
• Access to preventative testing programs, such as pap smear testing that was seen as limited for some groups a many women had never been tested in their country of origin.
• Poor dental care due to long waiting lists that can take months or years. One woman exclaimed, "Being without teeth is very depressing, it adds to our suffering."
• Doctors not spending enough time with women thus unable to develop trust for proper engagement with difficult or embarrassing health issues for women.
• Severe shortage or lack of female bilingual health professionals and paraprofessionals. Women want to see women doctors.

• Lack of English language skills was seen as one of the most critical issues for women in new and emerging communities drastically restricting access to services, employment and training opportunities.
• Limited availability of interpreting services, this was attributed to
  • Improper or lack of usage of interpreter services by service providers.
  • Long wait for interpreters.
  • Sometimes wrong interpreters provided, eg. Arabic spoken in African is different to Arabic spoken in the Middle East.
  • Lack of professional interpreters especially when dealing with complex health issues.

Incident at a chemist in Gilbert Road, Preston.

Lady with a child in a pram, in full hijjab, walks into the local chemist with a prescription in hand for ill child. First she is ignored till the old man notices her and tells the pharmacist that the lady with the child was before him. The pharmacist looks at the lady and tells her "we don't serve people like you". She left with tears in her eyes and looked at her feverish son.

• Fear of getting out in public again, in case the incident is repeated.
• Became isolated and stayed at home.
• Shared the incident with others and it lead the other ladies to feel the same fear.
• Felt vulnerable and a target for people to take their anger on them.
• Additional stress to their current fear and loss of family members overseas.
• Disappointment of finding safe haven in Australia, when they yearned for peace and risked their life to get here.
• Felt depressed and misunderstood of their treatment.
• Anxious about their children when they are left in school or not with them, eg. when on public transport.

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'Agnes' arrived in Australia in 2001 on a fiancé visa. She met her future husband via the Internet. Agnes was 27 at the time. She had a reasonably happy life in Poland, which included a full-time and satisfying job, a rented apartment and friends. Her parents died when she was a teenager so a close aunt brought her up and provided family support. Agnes was not looking for a husband via the Internet but simply started regular chatting with a man of Polish background who has been living in Melbourne for almost 20 years. Over time a friendship developed which included phone calls from him, sending flowers and encouraging her to come to Australia as his fiancé. Agnes concluded that he was a good man in view of the fact that he looked after two of his small children following the death of his previous wife in 1999.

Upon arrival, a wedding was arranged and two months later Agnes was expecting a child. Following the wedding, Agnes' husband became much more controlling, particularly with the finances and all social activities. Agnes had no friends of her own and most of her time was taken up with house duties and looking after two small stepchildren. Her husband's friends were her only friends, which meant that she could not talk to them about any of her concerns as she felt that their loyalty would be first and foremost to her husband.

As her situation was getting worse she did open up to a Polish woman whom she met through her husband. With that support she contacted a Polish organisation for assistance and Agnes decided to go to a women's refugee. Agnes was seven months pregnant at the time, had no income and no family support. She was soon to find our that her wedding date coincided, perhaps accidentally, with the second anniversary of her husband's previous wife's death by suicide.

The above points are not meant as an exhaustive list but merely a sketch of the more pressing and obvious impacts on health and well-being.

In this vein I will turn attention to older established women.

Brief profile

Post WWII mass migration, primarily from Mediterranean countries including Malta, Italy and Greece. Later migration from Turkey, Lebanon, South America and then Vietnam. Again to paint the picture, not comprehensive.

Generally women from these groups were unskilled and on the whole worked in factories and process plants, clothing, footwear and provided cheap labour through out work. Their experience on the factory floor was generally characterised by long hours, unsafe conditions, high incidence of injury leading to chronic pain and disabilities, lack of access to childcare and therefore high levels of stress and anxiety regarding care of their children and low wages to name but a few.

In 2004 most women of the post war mass migration are now in their late sixties and older. Particular issues of concern are the following:

• Isolation and lack of meaningful contact with community.
• Depression and a heavy reliance on minor and major tranquillisers.
• Ageing related health issues such as heart health, diabetes, strokes and dementia.
• Burden of caring for a spouse or disabled adult/children.
• Limited access to respite services, of lack of.
• Lifestyle issues; diet, obesity, reliance on gambling as a form of recreation and connection.
• Lack of recreational opportunities.
• Income support issues.
• Physical disability due to injuries sustained while in employment or acquired through illness, eg. Mobility or sight impairness with the onset of diabetes.
• Women tend to outlive their husbands, usually they do not drive therefore isolation and grief. For older women who have experienced torture or trauma before coming to Australia (at a time when specialist post-traumatic disorder counselling or psychiatric support services were limited) they continue to live with these experiences in greater confusion with the onset of other aged related illnesses.

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Add to the above low levels or very poor English skills, inability to negotiate the complex and fragmented service system, then one begins to get the picture that in Victoria at least we have a numerically significant and ethnically diverse group of women who have entered a stage in their lives where they will need access to services and a multiplicity of these if they are to live independent and healthy lives.

In respect to this group timely action is paramount. I am encouraged by initiatives by some Primary Care Partnership who have sought collaborative ways of addressing the need for information around core health issues affecting CALD communities. Partnerships between local community, health centres, councils, MRC's and ethno specific agencies are key to the success of these initiatives. A concern that I have however is that there is little, if any, funding available invested to these collaborations and so MRCs and ethnic agencies are burdened by over demand on their meagre resources. There is an overwhelming need for health promotion information to CALD women across key areas.

• Call for a strategy to integrate health and well-being policies and programs for CALD women across all areas of government.
• Resources to be allocated for health promotion to encourage partnerships between specialist providers, MRCs, ethnic agencies and other multicultural providers.
• Audit to be initiated within key departments re policy/program relevance to CALD women.
• Task force to be established reporting to the Hon. Mary Delahunty, Minister for Women's Affairs to impact at policy level for CALD women.
• Need to go beyond pilot programs to develop sustainable programs with special focus on CALD women's health and well-being

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