Is the health service reflecting the needs of ethnic minorities? Fiona Tyrrell reports
The most recent estimates from the Central Statistics Office (CSO) indicate that there are now 400,000 foreign nationals living in the State.
As the Irish health system struggles to deal with a significant broadening of cultural and ethnic diversity, communication problems and cultural differences are the recurring themes.
New research from the National Consultative Committee on Racism and Interculturalism (NCCRI) claims that there has been little change in structures or service delivery to reflect the specific health needs of members of Ireland's growing ethnic minority groups.
"Hospitals and other health service workers dealing face-to-face with people from minority backgrounds are left largely to cope with change as best they can," NCCRI's report entitled How Public Authorities Provide Services to Ethnic Minorities states.
Universal codes of practice concerning provision for minority groups do not exist in the health services nor are there any standardised or mandatory training modules in intercultural awareness or anti-racism, according to the report.
It also refers to anecdotal evidence that some GPs actively discourage patients from minority backgrounds, particularly Travellers and asylum-seekers, from attending their surgeries.
This fact can't "be denied", according to Dr Neill O'Cleirigh, a GP working in inner city Dublin.
Some doctors will refuse to see new arrivals to Ireland until they get medical cards. While it can take an Irish person on average six weeks to get a medical card, for a foreign national, who has no idea what they are doing, it can take up to three months.
These doctors seem to be unaware that the Health Service Executive (HSE) has a system where doctors are paid on a fee-per-item basis for asylum-seekers, he says.
More worryingly, however, it is not unusual in Dublin for doctors to actively discourage ethnic minorities from ever becoming patients, he says. This is not for "racist reasons" but because of the perception that foreign nationals are "very hard work".
"While I don't condone this, I can understand it," he says.
Minority groups are considered "hard work" because of language barriers and also because many have major psychological difficulties as a result of circumstances in their country of origin, he explains.
"Many can be very seriously disturbed and it is difficult to deal with them through an interpreter.
"I have treated girls who have just received positive pregnancy tests and they are absolutely devastated because they were raped on their way to Ireland. This kind of work can be quite draining."
Some foreign nationals, because they have come from countries with less developed health services, are heavy users of primary care services, O'Cleirigh says.
Patient expectations, as a result of significant cultural differences, can also prove to be a problem, he says.
Some expect to receive a prescription at the end of every consultation, as they did at home, and can be quite demanding, he says.
Dr Austin Carroll, who also works in the inner city, says there was evidence that asylum-seekers were being turned away from GP practices a number of years ago, when the number of asylum- seekers entering the State was much higher.
It is unclear whether this was as a result of discrimination or because practices were flooded with new patients, he says.
However, examples of good practice are emerging in Ireland. The Irish College of General Practitioners (ICGP) established a pilot interpretation scheme late last year. This allows GPs in the eastern region to avail of free telephone or on-site interpretation services.
The uptake for the service is steadily increasing, according to Dr Ciara McMeel, director of the ICGP's multicultural health project.
While using an interpreter makes a consultation two to three times longer, it is far superior to the alternative of using family members or friends, she says.
Providing interpreters is a step in the right direction. However, capacity needs to be built up and services must be made more accessible by educating foreign nationals in how services are delivered in Ireland, according to Stephanie Whyte, senior project manager with Cairde, a non-Government organisation working to reduce health inequalities experienced by ethnic minorities.
Lack of culturally appropriate service, racism from front-line staff and difficulty in accessing GPs or getting medical cards are some of the experiences of the Irish health service reported by ethnic minorities, according to Whyte.
Still in the early state of its migratory experience, Ireland has an opportunity to pre-empt or prevent some of the problems which could be two generations down the road, she says.
"We need to learn from the riots in Paris and the poor health status of Bangladeshis living in the UK."
However, a glaring lack of any hard and fast ethnic data in Ireland means that research-led policy is impossible in Ireland, she says.
People from ethnic minority backgrounds should be centrally involved in deciding how health services are delivered, she says.
Preliminary results from a Cairde-led assessment of the primary health needs of ethnic minorities living in Dublin's north inner city indicates that people are not aware of their rights, have low expectations, are confused about the various roles in the health service and have poor access to wider health services.
The study was carried out by 16 members of the minority community in Ireland who interviewed 100 people from a variety of backgrounds.
The communication barrier is the number one issue for ethnic minorities when accessing the Irish health service, according to Fidel Wanet, a member of Cairde's ethnic minority health forum and one of the study's researchers.
This lack of understanding can have serious implications for patients' health, he says.
Other key concerns expressed by those surveyed include stress and frustration caused by the asylum process, health problems as a result of poor accommodation and racism.
Access to GPs is also an issue, according to Wanet, who says he experienced difficulty getting a GP when he arrived in Ireland in 2003 with many GPs telling him their lists were full.
Dr Ronan Boland, vice-chairman of the Irish Medical Organisation's GP committee, says he is not aware of any situation where an asylum- seeker or foreign national was unable to access GP services.
At a time when there are 1,500 asylum-seekers coming into Ireland, some individual practices are overwhelmed and have to close their doors to all new patients, he explains.
Citing the significant workload associated with ethnic minority patients, he says GPs have been dealing with the language and cultural issues of this patient group since it emerged in the late 1990s. Despite the genuine needs of this group, extra resources have not been committed, he says.