Over The Horizon

Tailoring Refugee Health

Despite apparently experiencing high rates of post-traumatic stress disorder, Cambodian refugees in New Zealand are successfully living and working in their communities, calling into question the cross-cultural validity of symptoms of psychiatric disorders.

That's one finding by Nicola North, who has spent the last three years studying the transition from traditional Cambodian approaches to healing to the biomedical health system of New Zealand.

Some two million refugees of Southeast Asian origin are now widely scattered throughout the West. New Zealand has become host to some 10,000 refugees of Southeast Asian origin since the late 1970s, the majority from Cambodia.

Refugees who settle in other countries lose country and home, family and friends, lifestyle and livelihood. Many of New Zealand's Cambodians were bereaved of close family and are widely separated from surviving relatives and friends. Rice farming was the main occupation for most rural Cambodians. When they arrived in New Zealand they were faced immediately with needing to acquire both a new language and different life and work skills.

"The load of grief and work of adjustment is, without question, immense," says North.

Cambodian refugees, who have experienced among the highest levels of bereavement and trauma, have been found to show high rates of post-traumatic stress disorder. However, a recent study in Dunedin showed that those rated as having such disorders were not under treatment from clinics, but were operating successfully in their communities.

"In view of this, some researchers are now questioning the validity of results of surveys that use instruments developed among Caucasian populations," says North.

This study revealed that although Cambodians carry a high level of ill-health, their attitude to adjusting to New Zealand in general, and the health system specifically, is characterised by courage and openness to new ways, she adds. Findings demonstrated that the phenomenon of illness is highly complex, with a vicious cycle developing out of the interplay among difficulties in acquiring English, finding employment, poverty and ill-health. Onward migration is a step some take in an attempt to escape from this cycle.

There were many examples of intractable illness which eluded medical diagnosis and were not relieved by treatment. These made sense only in the light of the Cambodian system of healing, according to North. Their health-seeking behaviour demonstrates both a ready acceptance of the Western biomedical system and, at the same time, widespread use by the first generation of resettled refugees of traditional self-care techniques and remedies, with illnesses being interpreted in the light of Cambodian beliefs of causation and treatment as well as the given biomedical explanation.

"While this research was concerned with just one of the ethnic groups in New Zealand, the evidence that cross-cultural health care is complex and poorly understood has important wider implications," says North.

"Global conflicts continue to generate traumatised, bereaved refugees, some of whom end up in New Zealand. The ethnic mix of New Zealand's population is becoming more diverse and ethnic groups are establishing themselves.

Health care that is provided without acknowledging that different cultures express symptoms in different ways and do not respond identically to treatment is ultimately wasteful. The human cost is high, when refugees do not get better and their continued ill-health limits their ability to adjust and find employment."