COVID and confused
HOW INTERNATIONAL STUDENTS FRONT EMERGENCY WARDS UNNECESSARILY
Twenty three years working as an emergency nurse in Melbourne will give you more than plenty of stories, and good dose of wisdom. It’s a bedside insight into humanity at its best and at their worst. Eliza Burke has treated mass casualties from the Melbourne bushfires, and flown out to do her best for Sri Lankan tsunami victims and sat with a man who survived self immolation, holding his hand his dying hours before family arrived.
Her detached ‘professional emergency worker’ air has been hard won, but her soft heart and passion for her work remains close to the surface. She’s consoled countless grieving relatives, been attacked by ICE-addled hallucinating patients, been screamed and cursed at, but has had her share of random marriage proposals too. There’s countless car accident miraculous survival stories, and endless accounts of the infinitely whacky ways 19 year men find trouble. As mother of two young boys, she can’t help seeing many young people in pain through the eyes of a parent.
Unlike most nurses who ply their trade out of sight in closed wards, more than once Eliza’s work has featured on prime time Australian and British TV. She’s appeared with fellow members of trauma units at the Alfred and Royal Melbourne hospitals, team treating emergency patients in emotion charged bursts cool professionalism, action and tension. ER as reality TV has become a ratings winner in all corners of the globe. Never shy, Eliza has some pretty forthcoming insights on the plight of international students. Melbourne is one of the world’s great hubs for international students, and working in two of the higher profile emergency hospitals she’s seen hundreds, possibly thousands come through the door. There’s nothing particularly unusual about the case mix; the usual mishaps, car accidents, alcohol fuelled scuffles that befall younger people. She says international students are almost always polite, earnest and very grateful for the care they receive. What’s striking is their vulnerability and persistent confusion about the health care system they’re engaging with.
A recent experience ‘triaging’ in at the Royal Melbourne is a case in point. Late at night a group of young international students entered the emergency room fearing they may have contracted COVID-19. Saturday night is usually peak season at Melbourne’s emergency wards, but the pandemic had lulled usual city life, keeping people off the streets. It was quiet and there was time enough to usher the group quickly into an isolation room.
The group all complained of runny noses and one of who felt feint, wanted a COVID-19 test. Panicked and agitated, one seemed a drunk and especially confused. Though receiving patients with acute symptoms, Emergency hospitals are not designated testing stations. An onsite test was possible but it would be disruptive, time consuming, and because misallocated front line emergency work resources, very expensive. The students spent the night together in an isolation room, regularly checked on as, but essentially left waiting as kits and staff were assembled. Happily none tested positive but to perform such tests on the spot cost A$500 each, a good portion not covered by the students’ health insurance.
Their trip into hospital late at night was unnecessary, dangerous for themselves and potentially others. Eliza explains the simple truth is, the international students who enter emergency departments have little idea how the system works, or whether it’s the right place to be treated.
Simple insights that locals taking for granted like knowing the difference between the role of a general practitioner versus a doctor at a emergency department is lost on newly arrived students. “Of course, the fact that they’re ill prepared is not their fault. But every year, month on month it’s the same; vulnerable students presenting to emergency departments for silly reasons. Quite often they don’t need to be there. And who has responsibility? There’s a difference between a uni publishing guidelines on this stuff and kids actually getting it.”
Part of the problem is, that coming from different societies and different cultural backgrounds what seems obvious to a local just isn’t obvious to a new visitor.
“ Happily international university students don’t spend much more less time in Emergency departments than other cohorts of similarly aged people. But Eliza’s story shines a light of the difficulties international students face understanding issues around their own physical and mental health. Of course it’s a little ironic plenty of evidence abounds in the university literature.”
DID YOU KNOW?
Research has found that international students face a range of additional and specific risk factors relating to mental health. For example, a Bupa survey of prospective overseas students* in Australia found international prospects to be twice as likely to report “very low life satisfaction” than local Australian adults. Oddly there’s very little in the way of comparable literature when it comes to students once students are in their home country. But findings like these only highlight the need for both parents and institutions to stay aware (and committed to tackling) the unique set of health struggles faced by international students.
And this segues into the classic hindrance for international students: cultural perceptions and stigma around mental health issues. Despite help-seeking for mental health issues becoming the ‘norm’ in most Western countries, many cultures problematize mental illness. For example, a 2015 study* found that Asian American students in the USA were heavily influenced by stigma when seeking help for mental health related problems. It’s complicated, (and changing, thankfully) but students grapple with the cultural legacies of their home countries. For example literature suggests those from collectivist societies are more inclined to believe expressions of ‘personal weaknesses’ such as mental illness should be avoided to maintain harmony in society. And even today, this is a real barrier preventing students from seeking appropriate healthcare*.
A 2011 study by Forbes-Mewett and Sawyer* found many students’ inability to cope with simple daily tasks can lead to a range of mental and physical health problems. They found handling cooking, cleaning and budgeting alone for the first time can impact a person’s mental health. For example, it is widely known that new students often succumb to the temptation of regular fast food, alcohol and unhealthy snacks*. For international students who are less used to cooking or grocery shopping independently, obesity presents a greater risk.
A 2018 study by Gan and Forbes-Mewett found that international students did enquire about counselling services, but often did not follow through as they believed the service would not be useful. This suggests that healthcare services (particularly in the mental health field) could benefit from being more sensitive to the needs of students from a diverse and ever-growing range of cultures. But it also parallels other studies that point to a host of cultural, access and resource barriers prevent most international students from reaching out to university counselling services.
References
Fallon, F. & Barbara, D., 2005. Are our international students using the health system effectively?. Christchurch, New Zealand, s.n.
Forbes-Mewett, H., 2019. Mental health and international students: issues, challenges & effective practice, s.l.: International Education Association of Australia.
Forbes-Mewett, H. & Sawyer, A. M., 2011. Mental health issues amongst international students in Australia: perspectives from prefessionals at the coalface, paper presented to the Australian Sociological Assosciation Conference Local Lives/Global Networks. s.l.:University of Newcastle New South Wales.
Gan, J. & Forbes-Mewett, H., 2018. International students mental health: An Australian case study of Singaporean students’ perceptions. In: K. Bista, ed. Global Perspectives on International Student Experiences in Higher Education: Tensions and Issues. USA: Routledge, pp. 228-242.
Han, M. & Pong, H., 2015. Mental health helpseeking behaviours among Asian American community college students: The effect of stigma, cultural barriers and acculturation. Journal of College Student Development, 56(1), pp. 1-14.
Poyrazli, S. & Grahame, K. M., 2007. Barriers to adjustment: needs of international students within a semi-urban campus community. Journal of Instructional Psychology, 34(1), pp. 28-45.
Tomyn, A. J., 2019. 2019 mental wellbeing survey of prospective international and overseas students, s.l.: Bupa.
Williams, R., 2009. Fat is a student issue. [Online] Available at: https://www.theguardian.com/ education/2009/dec/15/obesity-student-health [Accessed 26 August 2020]