In recent years South Australia, like other Australian states, has witnessed a constant flow of new arrival refugees seeking humanitarian protection from situations of oppression, persecution and the antecedents of poverty and war.

Amongst these are women and children who are in great need of physical and emotional care and support. This article describes the experience and aspirations of women, gathered through the "New Arrival Refugee Women, Health and Wellbeing Project";. The project builds on the longstanding colaboration between the Migrant Health Service (MHS) and Women's Health Statewide WHS).

The multidisciplinary team at Migrant Health has been involved in the clinical, social and emotional assessment and treatment of new arrival refugees for several years. Since 1994 a women’s health clinic, run by medical and nurse practitioners, has provided assessment and treatment for women of recent arrival. This has been operating as a joint initiative between WHS and MHS.

Recent research conducted through the women’s health clinic, looked at the presenting health concerns of new arrival refugee women (Costa. 2001). The study indicated a strong correlation between women’s emotional symptoms and their perceived state of health. For example, the experience of physical pain, a common presenting problem, was often a powerful metaphor for past traumas and losses.

The findings of the research and the clinical experience of the staff at MHS, have highlighted the need to offer avenues for refugee women to explore, in their period of resettlement, the source of their physical and emotional suffering and to reconnect with their identity. It is within this context that the “New Arrival Refugee Women, Health and Wellbeing” project was conceived.

THE PROJECT
This project consists of two stages. The first stage, which this article addresses, was a community consultation with new arrival refugee women and service providers. The second stage, yet to be funded, is to develop a resource in collaboration with other service providers, which is a manual of information about a wide range of topics concerning new arrival women.

The aim of the community consultation was to gain a deeper understanding of women’s experiences and determine the scope of existing support programs. A project team of community health nurses, social workers, bicultural workers and a medical practitioner were involved in the planning of the project strategies and the conducting of focus group sessions.

This community consultation project had two components:
· Consultation with service providers through informal interviews

· Focus groups conducted with three main groups of refugee women;- women from Former Yugoslavia, Sudan and the Middle East.

THE INTERVIEWS
The service provider interviews involved workers from key agencies, ranging from health and counselling, to education and resettlement support. There were two main aims to the service provider interviews. To find out from service providers what they consider the main issues are affecting new arrival refugee women and to ascertain the range and type of support programs currently available for new arrival women.

The interviews highlighted four common themes. These included:

· Practical issues of resettlement, such as housing, transport, language problems, education and finances.

· Challenges, arising from the cultural difference between country of origin and Australia, commonly experienced through values and beliefs systems, norms regarding social behaviour and through the role of men and women in society.

· Physical and emotional health issues which present as both a symptom and a cause of distress, within the resettlement period. Pre migration experiences such as war, torture, trauma, family separation and lack of access to adequate medical care, often compound physical and emotional health symptoms.

· Women’s sense of self, which represents an array of personal and emotional issues many refugee women find difficult to articulate. Feelings of loss, loneliness, belief in ones self, hopes and dreams for the future and personal goals, are often obscured by the practical issues of resettlement. Implicit in the expression of sense of self, is the need for women to be understood within the context of complex, rich and diverse cultural stories.

This information, combined with the outcomes of the research (Ibid.2001), was used as a basis for the construction of a focus group format with the community women.

THE FOCUS GROUPS
Focus groups, in both community consultation and formal research, have become an increasing popular and effective tool in exploring the views and experiences of community groups. For the purpose of this project, focus groups were used as a way of evoking personal responses, which reflect the experiences of refugee women in coming to a new country.

Many refugee women coming to Australia have lived through experiences of imprisonment or internment in refugee camps, separation from family and loved ones, torture, rape, famine and loss of property and livelihood.

There were two main aims to the focus group sessions.

· To produce a line of questioning which validated the baseline information, gained through the service provider interviews, about issues concerning new arrival women.

· To find out from women how we as service providers, could best meet their support and information needs, through the development of a course or a resource.

To minimize the effects of variation between groups, such as age and cultural background, each session was conducted in a consistent manner.

Continuity with the staff involved in facilitating each session ensured consistency and rigour with the format. Documentation of the discussion was both written and tape recorded. Each transcript was cross-checked and analysed by the project team. A system of sorting through common themes and issues was developed with particular attention to describing the mood of the group and identifying factions or divisions. A summary of the focus group transcripts was presented back to individuals from each group, to cross check for validity.

Considerable attention was paid to creating a safe environment for the participants. All of the women, who were involved in the sessions, were known by the project team, who in turn had an intimate knowledge of the kinds of experiences and issues faced by the community women. Sensitivity toward emotional issues such as unresolved grief and the potential for personal disclosure was acknowledged. Each of the facilitators had experience working therapeutically with new arrival refuge women. Each brought to the process a range of skills from the various professional backgrounds, which included social work, nursing and medicine. The aim of each session was to establish an atmosphere of trust, openness, safety and sharing in order to take women on a journey, beginning with an open discussion about non-threatening practical issues of resettlement and ending with an invitation to explore deeper meanings about sense of self.

It was anticipated by the project team, that engaging women in a discussion about the experiences and challenges of resettlement would be straightforward. Our collective experience told us that women share readily when asked about tangible issues concerning themselves and their families. Encouraging women to articulate beyond practical issues into the realm of personal goals, dreams and ambitions would not be as simple. For many women, pre migration experiences as a refugee and the process of beginning again in a new country have necessitated a pre occupation with survival and dealing with loss. Many have not had the luxury of time, or an environment in which they feel safe enough to look into the future with hope.

THE THEMES
There were a number of common themes across the three focus group sessions.

· The aspiration to create a safer existence for themselves and their families
For many, coming to Australia meant a chance of survival.

“ When we were in Afghanistan we had no hope to be alive.”

Many women from Afghanistan spoke about ‘fleeing for their lives’ with little thought about where they were going, or what was ahead.

“ In my mind it was just to rescue my children and myself. I don’t wish for my children to be like the Taliban.”

Even though they had taken enormous personal risks, they expressed tremendous gratitude for their new lives in this country.

· Expectations of a better life in Australia
Many of the women from the Middle East had high expectations based on what they perceived as Australia’s high standing on human rights issues. They had not expected to be treated differently than other refugees. Women from former Yugoslavia spoke about the misinformation, which they received and how their expectations did not match their actual experiences in transit and on arrival to Australia.

· Lack of opportunities for employment and learning English
Language issues, together with dependency on the welfare system, represented common sources of distress for the women. As one woman put it:“ We are a Centrelink burden.”

Unemployment and the inability to communicate in English, deprived women of the means to connect with Australian society. For many women and their partners, the sense of social alienation and hopelessness had spiraled into a cycle of low self-esteem, depression and despair.

“I don’t know what’s wrong with me at this point. Psychological fatigue hinders my ability to achieve goals and any chance in this country. I don’t know if it’s because of being a stranger in this country or for being away from my relatives or being in Woomera for a long time.”

“ I have a lot of stresses. I just want to cry all the time. I am tired all the time. If you want me to cry now, I can cry right now. I can cry right now “.

· Sense of cultural dislocation.
Women who had spent a long time in refugee camps prior to coming to Australia, spoke of the profound sense of dislocation derived from the cultural leap from a third world environment, to Australia. All of the women described a sense of profound loneliness and being ‘lost’ within a new country, separated from family and community networks.

“Now I am in my house nobody, no one, comes and asks about me in my house. No one comes and talks to me. Because there is nobody who comes and talks to me I feel as though I am dead. Now that you are asking about me and when you called me to come here, then I knew that I was alive. No one asks my needs, no one talks to me here. They just left me. The Australian government people brought me here and just left me here”.

SUMMARY AND CONCLUSION

The process of bringing refugee women together in cultural groups, to talk about specific themes, was at times very moving and extremely powerful. Women valued the opportunity to share their feelings, their views and aspirations for the future. More importantly, they wanted to be heard.
In terms of support and interventions some of the issues raised by the women include:
· The need to address physical and emotional health issues.

· A desire to meet other women and learn from their experiences of resettlement.
· The need for community groups to work with service providers to form links and support.

· Access to language classes specifically for women.

· Sessions and groups that provide childcare and information about resettlement issues.

· Assistance in gaining job seeking skills and recognition of prior learning / qualifications.

· Information and support regarding the challenges of cultural change.

· A place of safety where women can express their cultural and religious beliefs.

· A group, which has a support and advocacy role, where women can voice their anger, concern and confusion about life in a new country.

· A group, which gives women the opportunity to explore creative outlets such as cooking and sewing.

The main recommendation, which emerged from the community and service provider consultations, was to use the focus group model as the basis for developing a program for new arrival women. This program will address the need for information, counselling and early supportive intervention.

A final project report detailing the community consultation outcomes and a course outline were completed in 2001.

Reference:
“Women’s Health Clinics: the many faces of empowerment” 4th International Women’s Health Conference Proceedings, Adelaide, 2001.

For more information contact:
Jan Williams, Community Health Nurse
Migrant Health Service
21 Market Street , Adelaide SA 5000 Ph: 08 8200 3912 E-mail: jan.Williams@dhs.sa.gov.au
Daniela Costa, Senior Medical Practitioner
Women’s Health Statewide
64 Pennington Terrace, North Adelaide SA 5006
Ph: 08 8239 9600
E-mail: daniela.costa@dhs.sa.gov.au