Characteristics of participants
Participants involved in this study represented Nepal (30.6%), India (30.6%), Sri Lanka (25.8) and Bhutan (12.9%). Among those, 60% were male and 40% were female and their ages ranged from 21 to 58 years with nearly 68% aged between 21 to 30 years. Over 93% participants have no reported chronic conditions and remaining 7% reported having either diabetes or high cholesterol.
All participants speak their native language at home and their migration time to Melbourne ranged from 12 months to 11 years. In terms of education, 29.0% had completed postgraduate, 40.3% had completed Bachelor, 22.6% had completed Diploma and 3.2% had completed certificate level of education. Most participants came to Australia for further education to begin with and settled gradually.
Participants' experiences gathered explored multiple barriers of accessing health services by South Asian migrants in Australia. Out of 62 participants, 27 reported the experience of communication, financial, social, and cultural barriers while accessing services in Australia. While analysing data, following key themes emerged; too long to wait: experience of accessing public health services; expensive but reliable: experience of accessing private health services; better than home: comparative experiences of using health services; and could be done better: expectations for future.
Too long to wait experience of accessing public health services
Participants shared their experiences of long waiting to access public services in Australia. The waiting experience resulted either delaying in seeking services or considering private options available. One participant shared her experiences of attending emergency services.
“I had to go to a public hospital because of an emergency condition. After several hours of waiting, I was finally able to meet the doctor. Once the doctor saw me, he told me that my problem does not require emergency treatment. They asked me to take Panadol and send me home. I wanted treatment, that is why I went there but I was not able to get it. Instead, they gave me big bills. It was disappointing. It felt like slapping my own face. This was completely unfair. The next day, I made an appointment with one of the Bupa clinics for treatment.” Participant 1, Sri Lanka
Participants’ experiences of long waiting became more complex when they had to pay for the services. This also confirms that not being able to receive expected treatment after a long wait created disappointment to participants. Their experience of disappointment led to the decision of looking for other options to seek services.
Another participant shared similar experiences of waiting to receive specialist appointment for treatment.
“I was referred by my GP to see a specialist at Alfred Hospital. First, it took several months to get an appointment. Second, it took another few month to organise treatment needed for my condition. It was frustrating to wait for too long. Anything could have happened during those waiting times; the problems could get serious. The waiting has been a difficult experience for me.” Participant 11, Bhutan
Participants found hard to manage long waiting, poor quality care and expensive services. When they were not able to afford private service options to minimise the waiting period, their experiences became more complicated. One participant commented how this scenario impacted the experiences.
“I have been in a situation of about a year-long waiting to get an appointment from a public hospital. Even after that long wait, I was not able to receive the treatment I needed from the public hospital. Everything was very slow. I know now why people go to private hospitals, but I cannot afford it. Public services should have better quality of care, so people don’t need to go private.” Participant 9, Sri Lanka
On top of frustrations created by long waiting to receive services, these experiences raise a serious question about the reliability and quality of services delivered by public hospitals which failed to meet the service expectations.
Expensive but reliable: experience of accessing private health services
Some participants who were able to afford private health services to minimise delay of getting appointment for the care they needed shared their experiences. Using private services was not their first preference but the long waiting in the public health system forced them to seek options for on-time treatment of their health conditions.
“As I was not able to receive care from the public health system, I had to make an appointment with Bupa [private clinic]. It was not my first choice, but I had no other options. I was happy with my decision, as the staff at Bupa explained the problems well. I was convinced with their explanations to organise required treatment. Their communication was good, and I felt comfortable and respected. Though I had to pay more money, I had a very good experience. This is how I like the health services to treat people.” Participant 1, Sri Lanka
Another participant highlighted the issue of high fee while accessing private health options.
My sister-in-law needed surgery. The public system mentioned about 12 months waiting, so we decided to use private. She had stone and it might have grown bigger and become serious if we did not make the decision to take out immediately. So, the surgery was done, and the stone was removed but we had to pay lots of money. It was hard financially as we needed to manage everything with a casual job and low income. But still it felt good to get treatment on time instead of waiting too long to be treated with extreme stress.” Participant 7, India
For some participants, the preference for using private services was based on the promptness of care.
“If we go private, any small or big procedure can be done quickly without needing to wait. It is expensive but there are no other options or choices to make. I started going to private clinics and getting treatment on time.” Participant 9, Sri Lanka
These experiences confirm that using private services was the only option rather than the choice to receive timely treatment for these participants. They had to make significant adjustments to their financial status to afford private care to manage health conditions. This raises another critical question about the limited access to care for those who are economically vulnerable.
Better than home: comparative experiences of using health services
Although participants raised serious complexity around managing long waiting time to receive the quality of care, their comparative experiences of using services in Australia compared to home country was better. It could be because most public hospitals in the South Asia region still struggle to manage the resources required to offer quality health care to their communities. A few participants made that comparison and were happy with the services. The survey demonstrated the following information about participants satisfaction of services received in Australia (Fig. 1).
In addition to the highly positive experiences that participants rated about the use of services and information, interviews revealed the experiences of communication barriers while accessing services. One interview participant compared the differences in communication among health professionals.
“In our country [Sri Lanka], we think that doctors are like a god. Whatever they [doctors] decide to do, we do not question, and we just follow them. Our doctors there [back home] do not explain to us what they are doing. I found this does not happen here [Australia]. We can ask questions to the doctors and they explained things clearly to us anyway. I like the services we get in Australia – it is much better.” Participant 12, Sri Lanka
Another participant made a similar comparison about the process.
“I like the system here in Australia. They [health professionals] ask for consent before commencing any treatment, so I know what is happening and I ask for clarity. I have options to say no if I do not want to go through the procedure – this is good. Also, we do not have to pay for most services. I did not see the system working like this in our hospital back home. Our doctors there [Nepal] make decisions and perform treatment. We have to pay for every single service we get.” Participant 4, Nepal
Better experiences in Australia were evident when participants compared the structure and way the services are made available to the community.
“In India, there are different kinds of hospitals and doctors. Some hospitals are known for special services, located in the main cities and are expensive. Same with the doctors – the better doctors are based in the cities and charge more. But in Australia, I did not see that difference. All doctors are good and treat their patients equally. Regardless whether you live in the cities or rural areas, there [Australia] is a better access to doctors or services.” Participant 13, India
It is not surprising to hear the positive experiences of the participants because of the socio-economic background and how health services operate in South Asian countries. Within these comparative experiences, participants shared the differences that could have been addressed to make services better for all.
Could be done better: expectations for future
Most health services are yet not able to meet the socio-cultural needs of communities. Participants shared expectations to address the barriers they experienced while accessing services in Australia. Most participants consistently stated their preference for more timely and affordable health services, having bilingual health professionals from the same culture, and respectful health service environment.
One participant shared the expectations for not having to wait a long time and affordable services.
“I really hope that we don’t have to wait too long to receive services. The government should provide additional resources to the hospitals, so we can get treatment when needed. They should provide more nurses, more doctors, and more beds. The waiting problem we currently experiencing while receiving care must be addressed by the government. Services should be affordable to everyone. For a developed country like Australia, they can do better to provide access to services.” Participant 9, Sri Lanka
In addition to affordability and less waiting time, participants wished for having access to the health professionals who speak the same language and understand their cultural background.
“I would like to see health professionals and interpreters from my own cultural background. They will understand me well if they share the same background and I can share my problems openly. This will make a big difference to my experience. Health services can match the professionals with my background by asking questions when confirming appointments. They [health services] can make this work.” Participant 11, Bhutan
Some participants experienced discriminations while seeking health care because of language and cultural differences. They believe that they should not be experiencing any form of discriminations or unequal treatment in the health service environment.
“Health professionals [doctors, nurses] should provide clear information and make sure that we understand what they are saying. I noticed that even in the reception, they do not provide enough information to us. I have seen them engaging in conversation with people who speak English well but that does not happen to us, as we cannot speak English well. They also do not pay much attention to us. I felt discriminated against and I think it should not happen. They should respect everyone and treat others equally.” Participant 2, Nepal
The experiences of discriminations that participants shared in this study raise a serious human rights issue that health services should take into the account seriously. No one should be discriminated against in receiving care on grounds of their socio-cultural background and health service is a critical place and must put concerted effort to make everyone feel safe, valued, treated equally and respected.