What’s it like working for a social enterprise clinic?

Ai-Lene Chan

22/08/2018 2:39:38 PM

Dr Ai-lene Chan writes for newsGP about her experiences working at a Brisbane clinic designed to help asylum seekers and refugees access healthcare.

Dr Ai-lene Chan described working in a social enterprise clinic founded on shared ethics as ‘uplifting and nurturing’.
Dr Ai-lene Chan described working in a social enterprise clinic founded on shared ethics as ‘uplifting and nurturing’.

When I first heard about a Brisbane clinic set up as a social enterprise, I was intrigued.
I’ve long been interested in refugee and multicultural health, an area afflicted by its politically charged reputation, and where seeking improving health outcomes rarely leads to increased public funding or resource allocation.
World Wellness Group (WWG) was set up to tackle this very issue. It came from the collaborative vision of health professionals determined to provide high-quality, reliable and accessible healthcare to asylum seekers, refugees and all other Australians living in Brisbane.
To achieve its goal, WWG’s founders opted for a social enterprise business model, meaning the organisation provides services in response to social needs.
I was fortunate enough to work with WWG in 2017, where I observed firsthand the indefatigable drive required to maintain such enviable ambitions.
The model
The social enterprise model means that no profits are provided to directors of the company, and services are provided either pro-bono or at reduced rates compared to the private sector.
As a GP, this meant that I worked beside other doctors, psychologists, allied health professionals and administrators who were united in their values. We believed all people, irrespective of their colour, ethnicity and migration pathway, had the right to healthcare.
I found working in a clinic founded on shared ethics to be uplifting and nurturing.
At a practical level, I maintained my income by dividing time between WWG and mainstream general practice.
The WWG clinic offers bulk-billing services, with some GPs returning all their billing back to the company. Other GPs at WWG are paid at comparable percentages to private practice, understanding that a proportion of their patients can’t access Medicare (due to visa restrictions) and WWG then provides the service pro-bono.
The practice refers patients through psychological therapies services (formally, access to allied psychological services) administered by WWG mental health workers, who specialise in culturally and linguistically diverse (CALD) therapies.
What I found ground-breaking at WWG (and other similar clinics) is the use of bilingual co-therapists who provide language interpretation and an additional layer of cultural liaison. Available co-therapists include people who speak Arabic, Tamil, Sinhala, French, Spanish, Romanian, Urdu Hindi, Punjabi, Indonesian, Malaysian, Yoruba, Pidgin English, Cantonese, Mandarin and Swahili.
The work
Working with such a diverse patient population makes for stimulating practise. As GPs, our emphasis on treating the patient, rather than the test results, is never more relevant than in CALD and refugee communities.
In the first instance, understanding someone’s migration pathway and the prevalence of disease in other countries is critical to making sure you order the right test.
Interpersonal communication requires some fancy footwork to achieve informed consent and adequate education via an interpreter. In particular, being aware of extreme variations in health literacy and differing health priorities between ethnic groups offers important self-reflection on the role of modern day medicine.
Chronic pain is an example that springs to mind. We understand that pain is multi-factorial and displaced people often experience loss through emotional distress and augmented physical pain.
Many ethnic groups with a history of displacement are unable to express this emotional distress through words translatable to English. As a result, I found that suggesting anti-depressants might help would often be met with indignation and confusion.
Last, but not least, is the challenge in negotiating financial limitations of investigating and treating illness where people have no access to Medicare and no reliable source of income.
Many GPs I talk to are surprised that individuals and families in the Australian community have visas that exclude them from public services, the Pharmaceutical Benefits Scheme (PBS) and work rights. These exclusions are often due to abrupt changes to federal policies – and those affected usually know as little about them as we do.
Most recently, the Government has reduced status resolution support services (SRSS) funding to many who have pending protection visa applications. Processing of applications has essentially stagnated. This means the burden of healthcare, psychological support and social or settlement services falls indefinitely to community organisations such as WWG.
As an Australian of Malaysian heritage, I come from parents who were looking for a safer home offering better economic opportunities. It’s with a sense of responsibility that we can return the favour to those facing the same challenges of our parents, or grandparents, to give them some dignity and opportunity to live healthy lives.
WWG is a social enterprise and registered charity that integrates western and traditional medicine for the enhancement of healthcare, research, education and advocacy.

asylum seekers refugee health social enterprise clinic World Wellness Group

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