GPs ‘critical’ in coronavirus response for CALD communities

Anastasia Tsirtsakis

13/03/2020 2:41:18 PM

Examining the importance of disseminating information to culturally and linguistically diverse communities.

Doctor explaining to older woman
GPs are a trusted source of information and have a particularly key role to play in helping to provide information to CALD communities.

More than a third of Australians aged 65 and older were born overseas.
With 21% of all households speaking a language other than English at home, and older age being a factor in coronavirus fatality rates, there is a pressing need for access to detailed and accurate bilingual information.
The Department of Health (DoH) was quick to develop coronavirus material in languages of highly affected countries, such as Chinese, Korean, Farsi and Italian. As of Thursday 11 March, the Department of Health and Human Services Victoria made its translated resources available in 25 languages.
To date, community health service cohealth has the most extensive selection of language-specific information, with its website equipped with an instant translation service.
Dr Kate Walker, Chair of the RACGP Refugee Health Specific Interests network, is liaising with the Victorian Refugee Health Network to gather resources and advocate for more information given refugees in particular are ‘already quite a high-risk group for poor health outcomes’.
‘They might have undernutrition, undertreated chronic disease and they might be living in overcrowded temporary accommodation. In addition, social isolation, discrimination and mental health problems mean they have fewer resources to cope with this pandemic,’ she told newsGP.
‘If there’s not a good rigorous response around containment, coronavirus could spread more easily in these vulnerable communities. So I think we need to put a lot of resources into prevention in these communities, making sure people know how to respond when they have symptoms, and supporting confirmed cases to ensure that the home isolation measures are followed correctly. And that’s about education.’
Dr Walker emphasised the need for a ‘coordinated and creative’ governmental response. She stressed the importance of working directly with different multicultural organisations and community groups in order to develop targeted information and ensure it is disseminated correctly. 

Another challenge to relaying information regarding infection control measures is the discouragement of social gatherings, which is often a key way of culturally and linguistically diverse (CALD) communities communicating.

As a GP, Dr Walker recognises doctors are a trusted source of information and have a particularly ‘critical role’ to play in responding to this group.
‘We are a really fantastic resource in the pipeline around explaining prevention, and how to contain this illness and how to comply with the home isolation of interventions to these groups,’ she explained. 
Dr Christos Pavlidis is a bilingual GP who often speaks to his elderly Greek patients in their native language. He acknowledges that CALD communities can be a difficult group to access when it comes to health campaigns in general.
While it is ideal for at-risk patients to have a GP who can speak their first language, Dr Pavlidis says it is certainly not vital and agrees GPs as a whole have an important role to play.
‘I think what’s important is that people have a trusting person that they can rely on. In these circumstances, I think people need reliable, accurate and trustworthy sources and that’s probably more relevant rather than language specifically,’ he told newsGP.
‘Having said that, I think the community in general, in the widespread sense, is struggling with the whole concept in terms of finding out what the current information is and what the current best advice is to the situations evolving.’
Dr Walker recommends GPs use the three-step teach-back method with CALD patients.
‘You check the patient understands your treatment plan, and that means number one that the clinician can explain to patients the diagnosis or the treatment plan with an interpreter [if needed], and then the patient explains or teaches back to the clinician what was said through the interpreter,’ she explained.
If the patient cannot demonstrate they have understood exactly what the clinician has said, the clinician then needs to try a different way to explain and assess the patient’s understanding of the treatment plan.
Meanwhile, before patients even step through the door to see their GP, Dr Walker recommends a number of tips for general practices:

  • Resources placed on the front door, both pictorial and multilingual, covering risks of having travelled from a high-risk country/having been in contact with someone who has travelled abroad in the last two weeks; information about symptoms; information about interpreter use (with an interpreter symbol)
  • A triage system through the reception desk
  • Reception staff should know how to access interpreters
  • Detailed patient education resources translated into multiple languages (pictorial/audio/videos) with detailed information about the disease; tips on what to do if they are a close contact or a casual contact; how to approach home isolation;basic information about prevention and hygiene etiquette
With a series of religious holidays that often attract hundreds, if not thousands, of people to sites across the country soon approaching, the need for cultural awareness is particularly important.
Sacraments during a religious event may carry a high-risk of transmission given the close human-to-human contact, such as accepting Holy Communion. In the Greek Orthodox Church, for example, this entails consuming wine from the same spoon and chalice as all other parishioners, many of whom are likely to be elderly and at a higher risk of contracting coronavirus.
Despite concerns regarding community transmission, Reverend Steven Scoutas, a spokesperson from the Greek Orthodox Archdiocese of Australia, told the ABC that communion would be administered as normal.
‘Once we decide to go to church, we believe there is absolutely no possibility of contracting disease from the holy cup,’ Reverend Scoutas said.
‘We believe that no disease or illness can exist in holy communion.
‘It comes down to religious rights. If a government is going to impose its own view on matters of faith, where does one stop? We will continue as we have during the [past] centuries.’
The church’s stance has been criticised by the Australian Medical Association (AMA), calling the position ‘ill-considered and unscientific’ and saying it is ‘putting people at risk’.
The AMA’s Associate Professor Julian Rait told the ABC that using the same spoon could spread saliva, and therefore coronavirus if present, from one parishioner to another. Traces of the virus were detected in the saliva of 90% of infected patients, a Clinical Infectious Diseases study found.
‘I would doubt very much their faith would provide the protection they believe,’ Associate Professor Rait said, urging the church to change its position.
Meanwhile, both the Catholic and Anglican churches have stopped serving communion from a common cup.

Dr Pavlidis said it is important for GPs to understand the potential cultural and social significance of such events for many. He believes a balanced approach in accordance with government-issued advice is key.
‘With the current caseload in Australia, we’ve got to maintain a balance between telling people to avoid everything and being very paranoid and encouraging them to continue on with life as normal,’ he said.
‘But the advice may change over the next few days or even few weeks.’
This is where Dr Walker says GPs need to take the time to understand each patient’s perspective.
‘Assess what their knowledge of the disease is, what their beliefs are about transmission, and inform them about the facts according to what we know as they evolve - and that’s a rapidly moving field,’ she said.
‘It’s hard enough for us to keep in touch, let alone people who have limited English.’ 

Prime Minister Scott Morrison announced last week that the Federal Government had advised all non-essential gatherings of more than 500 people should be suspended from this week. He added that churches might have to consider extra services to keep numbers low; however; it remains unclear how authorities will ensure this is the case.
Dr Walker believes community leaders from CALD communities also have a vital role to play in keeping vulnerable people safe.
‘For those who may be aware that there are cultural practices that might put members of their community at risk, I think it's important for them to actually self-nominate and work with health professionals around what is the safe practice and adapt their practice,’ she said.

‘We need to work closely with the CALD community to ensure the health messages around coronavirus reach them. The Government needs to deliver these messages on a population level, targeting CALD communities. GPs need more patient education resources to help them in this work with individuals.’
In an effort to take some of the burden off GPs, Dr Walker recommends the Government develop an app targeted to people with low literacy with some pictorial information and translated audio, explaining all stages of the virus.

‘How we respond to our most vulnerable will be critical in preventing wider spread of coronavirus in Australia,’ she said.
‘Patient information and education are essential both from government and individual GPs.’
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Dr Paraskevi Kokkinis   17/03/2020 8:20:11 AM

In a religious culture such as the Greek Orthodox faith it is perhaps better to focus on the high risk of proximity, large gatherings, risk for the aged rather than the Holy Cup. These risks are enough to cancel these gatherings without offending the belief of communion wirh cup sharing.