Supporting Afghan refugees adapting to London
Dr Ethie Kong spent 30 years as a working GP in Brent, 6 years as CCG chair and several in a hospital setting. Instead of stepping back at retirement age, she moved to Westminster to work in a local practice as a GP and clinical lead, in addition to her voluntary work supporting the Chinese communities in Soho and Brent. Here she journeys how her support for Afghan evacuees housed in a local hotel has led to award winning work that has been adopted by other trusts and the Home Office, as an example of best practice.
Saturday and Sunday
The weekend helps me refresh my batteries and plan for the week ahead.
I get to meet people in the most disadvantaged communities, whether evacuees or those with long-term conditions, with language and cultural barriers in the Chinese communities. I also do some charity work – I’m chair/trustee to Brent Chinese Association Charity and a trustee at Ashford Place Charity.
Dr Chi Chung, a GP and trustee, and I run pop-up weekend advisory sessions, supported by bilingual or trilingual volunteers in culturally sensitive areas. During the pandemic, lockdown and subsequent easing, we hold free joint Covid vaccination and advisory clinics which are very popular, especially amongst people who can’t afford to take time off during the working week.
We recently had a Covid vaccination bus and community health and advisory event at Bang Bang Foodhall, a busy and popular North London street food venue - with 200 attendees!
I also make time to catch up with friends over a lovely meal.
I complement clinical work with my work for Afghan evacuees. We have weekly Afghan Partner Support meetings on Mondays, where all partner organisations meet virtually to update and discuss any issues. It’s led by the council and all the partners attend – various NHS CCG, GP federation, acute, secondary, mental and dental health, children services, council, schools, voluntary organisations, job centres and Government representatives.
When the evacuees arrived last August and September, it was an emergency, with nothing in place and all hands-on deck.
Their health and emotional support needs were prioritised, and medications required. The council settled in the evacuees and organised on-site support, while I and Dr Rishi Chopra, as clinical leads, set up the GP hub at the hotel.
We had support from translators, the council, Healthcare Central London and more, to do all we can in one place with our available resources.
As my practice is nearby, I visit the bridging hotel where the Afghan refugees are staying.
Many Afghan evacuees we care for came here with nothing. The beauty of the GP hub is that we could quickly provide both proactive and reactive care on-site, signposting them to local receiving GP practices for tests and services which aren’t available here.
I then attend Westminster Primary Care Board meeting after some remote working for my practice. The board is a joint primary care commissioner and GP provider/PCNs meeting with shared leadership. I give Afghan GP hub update reports to this board.
Tuesdays usually also see another Afghan evacuees’ accommodation meeting.
An immediate priority was to ensure appropriate understanding of NHS systems and signposting to health services, so with the local council we organised informal talks on the topic with the residents and produced a series of translated leaflets that explained how to access the GP, A&E, pharmacy, dental care and opticians, etc. These have been adopted as examples of best practice and are now being used by the Home Office to support other refugee communities throughout the UK. I have also been invited to deliver talks to other boroughs.
I’m not on call for my practice on Tuesday, so do clinical admin work and support the on-call doctor if required.
I meet a woman in her 40s. She initially was seen the GP hub, complaining of chest pain, then came to my practice where we did blood tests and discovered she was diabetic. We also did an ECG as she had an irregular heartbeat. This was grossly abnormal, so she was swiftly signposted to A&E. It turned out to be angina, and she also needed a pacemaker fitted.
In Afghanistan, her conditions weren’t known. The evacuees haven’t come to the country with any health records, so it’s rewarding to uncover these unmet health needs and offer treatment.
Because not all areas across the UK have GP-to-GP transferable record systems, even when there are GP-to-GP systems in place, records are sometimes slow to reach the new GP. When someone moves away, we always place printouts of a patient’s medical notes (with their full consent and safeguarding compliance and the help of the GP federation), alongside any treatment notes or hospital records in a sealed envelope, so every patient can pass this on to their next GP.
Before I start my clinical day on Wednesdays, I contact the healthcare assistant at Ashford Place, where I’m a trustee, to check with her that her health advisory clinic is running smoothly, and to give support.
I visit the hub to speak to the families and ensure that people on the ground are happy. I work closely with Sandra, the local authority’s support manager, and Shireen, the LA’s family support worker. She always ensures translators are available if the evacuees need to attend hospital appointments.
We also work closely with St Mary’s Hospital’s team, as well as the local authority’s public health team, CNWL MH Foundation Trust and voluntary organisations supporting mental health, as, unsurprisingly, trauma is a common lived experience.
A vital part of the hub’s work has entailed getting patients of all ages vaccinated - flu as well as Covid - and ensure all the children’s immunisations are up-to-date. We also screen for TB and hepatitis, which are quite prevalent in the Afghan evacuee population.
On Thursdays we have the half hour weekly cardiology advice and guidance session with cardiologists from Imperial, where we bring our cardiovascular cases for discussion and advice and guidance. We also have monthly virtual Paediatric MDT meetings and PCN meetings.
Then my afternoon clinical session awaits me!
Many of the evacuees are in the process of being housed in homes all around the country. Collaboratively working together as partners under one roof, to ensure their health and social needs are met is so rewarding – we’re united with the one aim of supporting this vulnerable population. This strong, established relationship between health and LA leads and other partners bodes also well for the future delivery of care through the ICS.
We’re also now in a much better place to support other vulnerable refugee communities who seek support in our borough.
Fridays are my busiest days. I have a full clinical day and am also the on-call doctor!