Jacinta Bongiorno, Settlement Health Coordinator & Refugee Health Nurse


You’re listening to Communicate with Zen and John from Empower Your English.


Zen:                 Hi everyone, welcome to Communicate Podcast.  This is Zen here, and with my co-host, John.


John:               Hey Zen, back again for another fantastic podcast.


Zen:                 Yes.  We are so excited though, today we have Jacinta Bongiorno who works as a refugee health community nurse to share her community strategy and stories.  Welcome.


Jacinta:            Thanks for having me Zen and John. 


John:               Good.  Tell us a bit more about yourself.


Jacinta:            So I’m a nurse, I studied in 2006, a Bachelor of Nursing.  And from there, I’ve travelled the world.  I’ve lived in Africa, I worked as a nurse there.  And then I’ve come into refugee health nursing in Melbourne and I’m getting married soon, and I have a son, Charlie.  And a cat.  And now I’m working with settlement agencies as the only nurse clinician with case managers for the new arrivals into Australia on the Humanitarian Settlement Program, and also with people seeking asylum. 


John:               So, for people listening around the world, what is a settlement centre?


Jacinta:            So a settlement agency, they help people, so normally refugees coming into Australia.  They help people access services within Australia so they will help them access bank accounts, get into housing, education, and also importantly, health, and that’s where I come in.


John:               These people have come in from around the world, haven’t they?


Jacinta:            They have, yep.


John:               For different reasons?


Jacinta:            Yep.  So with refugees, it’s mainly when they’re fleeing war or, yeah, civil unrest.  Yep.


Zen:                 So mostly, your role is to support them to be included in the community, …


Jacinta:            Yeah.


Zen:                 … to access the services?


Jacinta:            Yeah, absolutely.  So we do a lot of work, because our service is quite different to these, where these people have come from, we do a lot of work in education, but also advocacy because these people have different needs that we’re not really used to often.  And so, yeah, there’s a lot of work that we’re sort of, it’s behind the scenes or you can’t really write it down, it’s just sort of being with that person and making sure that they’re accessing the services that they know that they can now access.


John:               When you say services, all services or mainly health?


Jacinta:            We sort of work on the social model of health.  So primarily, it’s, you know, primary health services like GPs and allied health, and then into hospitals as well.  But also, you know, if you look at the social model of health, you know, there’s all these good things help with good health, so we want to make sure that they’re linked in with their community, they’re doing things that they really like doing, they’re learning English, they’re linked in with their religious organisation.  And when they’ve got these good connections with community, you often see better health outcomes.  Yep. 


Zen:                 So, we already touched on supporting refugees here, like, which English is their second language, maybe some of them have challenges in speaking English as well.  So thinking about the communication, how important is the listening and also supporting them to communicate within the health setting, like, from all perspective, maybe from the nurse perspective, maybe from refugee’s perspective, do you have any ideas or stories about that?


Jacinta:            Yeah, you’re right, and people come from different areas of the world so they might have different levels of literacy, different levels of English.  You know, English might be easier for them to pick up, it might be really hard.  I know it’s my only language and I still struggle with it.  So when these people come in, we want to make sure that we’re really listening to what they need and so we always make sure that we’ve got an interpreter.  And often when we’re working with other services, we are often advocating for people to use interpreters because health and, you know, all this education is really important. 


                        But, you know, listening is sort of one part whereas, you know, with communication, we all know that there’s so many different parts to it.  And so when we’re sitting with a client, there’s normally an interpreter there and we’ll be talking and they’re speaking in their language, but there are little cues that you can pick up on.  And, you know, I’ve worked with a few children and often we’re relying on the interpreter to tell us, actually, this child is stuttering, or this child isn’t making sense, or this person isn’t connecting how you normally would in their language.  And so, we might not see that because we don’t understand the language but we’re relying on the interpreter to listen as well. 


                        So everyone’s trying to listen in their own way, it’s quite, you know, intricate and complicated and that’s where you want to make sure that you’re picking up on other cues as well, you know, how are they speaking to you, are they really quiet, but is that a cultural thing, but is it that they’re scared of the person they’re next to or they don’t feel comfortable because maybe you’ve got an interpreter that might speak a different dialect, or might be male or female.  And so there’s all these different things when we’re communicating with these people that we just have to take into consideration.


John:               Do you give the opportunity to meet the interpreter beforehand, …


Jacinta:            We try.


John:               … to get a feel for who they are and what makes them tick?


Jacinta:            Yeah.


John:               Because I think what you’re saying makes a lot of sense.


Jacinta:            Yeah. 


John:               Yeah, where they come from.


Jacinta:            Yep.  It’s quite, you know, we’re going quite quickly and we’re time based but we do try and talk to the interpreter beforehand and if we know something about the situation, we might try and brief them.  But that might also be really difficult if we’ve got a phone interpreter because we can’t get access to an actual onsite interpreter.  So, you know, we have examples where people are sharing really awful stories with us and they don’t want a person, an interpreter with them because they’re from the same community and they’re worried they’re going to share it.  Even though interpreters are really good and they know not to share that confidential information, but often we’re asked to have a phone interpreter. 


                        And sometimes, if we have a phone interpreter, they might be doing something else at the same time and it’s a really heavy conversation and so that’s where we have to make sure that we’re not causing any further problems to this person who’s sharing a story, and we’re ensuring clear communication and we know that this person knows that we’re there for them, that we’re trying to build rapport with them.  And so there’s a fine balance where you’re hoping that the interpreter is really getting that communication across and, you know, building the relationship that we’re trying to build with the client that includes trust and honest communication.  So, it can get quite complicated.


                        And then, you also want to make sure at the end of the consultation, if it is quite heavy, that the interpreter doesn’t go away, just sort of left there.  You want to provide them with support and, yeah, I think it’s a fine balancing act but, …


John:               Oh, for sure.


Jacinta:            Yeah. 


Zen:                 Yeah, so, like, during supporting them, the refugees in the health setting, usually you would have the interpreters on site, you support them to interpreting and communicating, but if, like, in that situation, does the, or do the refugee or the people, do they always search before they’re talking with others, like, for example, GP or a nurse or even maybe social workers who will support them in a health setting.  That would benefit them to communicate with the health professionals?


Jacinta:            Yeah.  People talk within their community so they might have some ideas on what they expect within their own community, and that could be different to what we sort of have in our society, absolutely.  And I think that’s where our role is really beneficial because we can get an understanding of what these people know about their healthcare and what, maybe they don’t know.  And we can provide them with strategies while they’re talking to other professionals, and provide advocacy.  In giving these, you know, often we’re giving women, you know, this is a new concept but they can choose their healthcare and they can ask questions and they can actually say no, I don’t want this, I want another opinion.  And this is all new to them. 


                        And so this is where our role is quite important because we are giving them these strategies and education to say, no, you don’t need this, or why do I have this, what might have come from this.  And if they’ve got their own research, that’s brilliant and we want to listen to what they already know about it, and that might be asking direct questions, it might be just watching how they’re interacting within the consultation, if they’re asking the right questions.  Yeah, I think that’s really important. 


                        It’s also important, if you flip it with the health professional, that they’ve got this understanding that people have different cultural knowledge or, you know, education, and they’re coming in.  You know, we’ve had people present to emergency and they’re saying, physically, they’re saying my heart hurts and so the emergency department does all the right things, they do all the heart checks and then they find nothing.  And then they’re like, no, you’re fine to go.  But what they were actually saying is, I’m really sad and this is where I’m showing my pain and this is how I’m communicating it to you. 


John:               Wow, that’s, yeah.


Jacinta:            Yeah.  And, you know, and other cultures hold pain and bad thoughts in different parts of their body, …


John:               Wow.


Jacinta:            … and it’s really interesting.  It’s hard to get research on this because it’s very individual and, you know, people might feel a really bad tummy ache but it’s actually because they’re, you know, really sad.  Something bad has happened at home, where they’ve come from, and they’ve come to Australia and, you know, maybe they might have had a trigger and, you know, that’s how they’re presenting their sadness or their pain.


John:               How are we getting this feedback back to the medical profession?  Because I think, you know, hopefully they’re listening to our podcast. 


Jacinta:            Yeah.  Hopefully.


John:               Yeah.


Jacinta:            Yeah, this is great, thanks for the opportunity.


John:               It is.  No, but I think it’s really important that, …


Jacinta:            Yeah.


John:               … our doctors and nurses are getting this feedback about different interpretations of pain and location.


Jacinta:            Yeah.  Yeah.  And it does come back to education.  But it’s also, in our role again, it is to make connections and network with health professionals and, you know, health professionals are doing so much, they’re working on so many different people and you’ve got to remember, everyone’s an individual and everyone’s going to present differently.  So we do do a lot of education on what we’ve seen and what we are presented with, but it’s also, yeah.  You know, if we’re providing feedback to a service and it might not be nice feedback, you know, you want to do like a compliment sandwich. 


                        And you’ve got to understand that these people are, you know, in emergency, they’re going through thousands of people a day, you want to really congratulate on being able to do this but you also want to make sure that my client is getting the best care that they’re entitled to, and they might not be sticking up for themselves or they might not be saying this.  And it’s really important that you do follow up, and I think the best way to do that is with relationships and networks.  Yep. 


John:               I’m a bit of a jargon buster, …


Jacinta:            Yep.


John:               … I just want to pull you up on a word which I love.


Jacinta:            Go for it, I hate jargon too, I’m sorry.


John:               A compliment sandwich, …


Jacinta:            Oh, yeah.


John:               … please tell the world what a compliment sandwich is.  I love it.  Stop laughing and tell us, what’s a compliment sandwich?


Jacinta:            So say if you’re giving some feedback to, maybe, a health professional who might not have used an interpreter or provided clinical care but, you know, the client might not be happy with it.  You might give them a positive, you know, thanks so much for seeing these people, it’s really great, you know.


John:               That’s the top layer of bread.


Jacinta:            That’s the top compliment.


John:               Yep.


Jacinta:            And then you really get them with the, but, this person came back and they’ve told me that they didn’t actually have a choice and they didn’t feel like their questions were answered and it’s concerning and, you know, I feel worried about my client now.  And then that’s your feedback. 


                        And then the next one is, so maybe next time, if you want me to be there or if you want some education or you want some help with any support, I’m happy to do that.  I just want to make sure that this person is looked after and anyone else that presents similar is also looked after. 


                        Does that make sense?


John:               Okay folks, there you have it, a compliment sandwich.  I’ve heard a different version Zen; it was called a shit sandwich.  So the first bit of bread looks good, the bottom part, but when you bite it, it tastes awful.  The same sort of thing, same philosophy, would you agree?


Jacinta:            Yeah, absolutely. 


John:               Okay.  Don’t be fooled by what you look, it smells good but when you bite into it, oh my God.  Anyway, so Communicate’s all about jargon and words, we’ve now learnt about a compliment and a shit sandwich.  Back to you Zen.


Zen:                 Yeah, thank you for both, I learnt new things tonight.  So, as you said, when you’re supporting [0:14:05.8] and so, people from a refugee background, and sometimes they will speak up because of your [0:14:14.8] or advocating for them sometimes.  During your experience as a nurse, do you have experience in any situation when an individual is feeling that they are being discriminated against?  And if that’s happened, so what’s some simple steps that can be taken, maybe by yourself or even by the individual?


Jacinta:            Yep.  This is really difficult because we deal with discrimination a lot, and it might be on the spectrum of, just a little comment to proper problems that haven’t been addressed.  And normally our clients don’t want to rock the boat, they don’t want to bring up anything, they’re really appreciated and they don’t want to make a big scene, basically.  Whereas I’ll see it and think, how dare that person treat you like that, that’s disgusting, I want to say something.  But I can’t say something to that clinical without the consent of my client, and if the client says no, it’s fine, I just don’t want it to happen again, we’ll make sure that they’re looked after by another person.  But if you can get the client to consent, it is important to make a complaint. 


                        And it just depends on how the health service takes it, you know, if they think it’s a criticism or if it’s a learning opportunity.  And you’d hope they’d think it was a learning opportunity but sometimes, you know, they might take it quite defensively and that would be for different reasons.  But I think that’s where a rapport needs to be made with people who are vulnerable that need support with advocacy and empowerment.  And that might be with my role, it might be with someone from the church who’s just become friends with them and they’ve shared their story, it might be with, you know, anyone they meet and there’s a rapport built.  And then this person, they’ve got a trusting relationship and then the person can sort of attend appointments with people and just, you know, be just there silently sitting there but they feel, you know, I know that Jacinta’s got my back, I can ask the questions I need to. 


                        So, if possible, it’s good to make complaints and you want the service to, you know, make it as a learning opportunity.  But if not, you want this person to feel like they’ve got a rapport with someone they trust that can actually talk to these services and say, actually, I need a bit of help, let’s not do that again.


John:               It’s a really good point, when you talk about rocking the boat, which basically means they don’t want to cause any stress or drama. 


Jacinta:            No.  Yep.


John:               But what you said Jacinta, you’re there and there are other people there who have got your back, which means they’re behind you to support you, so it is okay to listen to your heart, your soul and your heart to say, this doesn’t seem right.


Jacinta:            Yep. 


John:               I won’t say anything now, …


Jacinta:            Yep.


John:               … but do you encourage them to go away and say something later?


Jacinta:            Yeah.  And we’ll follow up with them.  It’s good to be in my role because you can be creative, so you can give them other options.  I think, it’s just really important to, you know, the rapport keeps going, you know, we make a relationship with these people and, you know, we might ask them a month or two later, actually, how are you feeling?  You know, I know that that was a really bad time when the service didn’t provide the good care that you deserved, how are you feeling now?  Do you think you might be ready to explore other option or you’re not ready?  And it’s just completely up to that individual.


Zen:                 Yeah.  So actually, you have touched on that, like, when the individuals, they have some friends or other some other sister or brother or the church to give them company, to attend the appointments so that is really supportive and helpful for the refugees.  And from the health setting, like, for example, if the refugees, they would like to give the constructive feedback to the health setting, do you know if the health setting or the department, they have any platform or any ways for them to express those ideas?


Jacinta:            Yep.  Yeah. 


Zen:                 Yep. 


Jacinta:            Health services, you know, at the top, they’re always looking for feedback and ways to improve.  And that’s where we can help with clients if they actually want to make a complaint, or if they want to give feedback, you write, if you want to use a different word.  Yeah, services are always reflecting and trying to learn and I think that’s a really good, you know, that could be in the compliment sandwich, you know.  People, services are always trying to be better and they’re always trying to be client centred, they always want the client at the centre to feel like they can make their own choices.  And that’s where we need to make sure that these people know that they can do that, and that’s education to the client, and it’s also education to the services, that, … 


                        Actually, you know, we’ve got examples where young people from a torture and trauma background might sit in a hospital bed and think, oh my God, you know, it might trigger something to what’s happened in their past.  And, you know, the nurses are doing great work, really good, but they don’t realise that they’re potentially being part of a trigger situation where this person feel really scared and, you know, it just might be about the nurse saying, you’re here, you’re safe, if you need anything, I’m here.  We’ll get an interpreter the whole time, you won’t sing anything without knowing it, you know, it’s just about giving that education to everyone in that person’s care to say, look, it’s just about being aware. 


                        And you don’t have to know everything as well, it’s good to just ask questions as well.  You know, are you feeling okay, you don’t look, you look a bit scared, you look a bit worried.  Do you want something?  Do you want me to call someone?  You know, just being a bit empathetic and a bit flexible as well, I think flexibility is really key and flexibility can be quite hard with funding and programs being quite strict, and, you know, getting the numbers in.  I think that’s where the flexible role is really beneficial to sort of say, yeah, you actually need your mum here, how can we get your mum into this situation so that you feel safe, your mum can ask the questions for you.  You know, things like that. 


John:               Looking at it at a systemic level, which means like an industry level, people are labelled and branded and stigmatised on words like refugee.


Jacinta:            Yeah.  Yep.


John:               So, obviously, you must come across that with the health profession.  It must frustrate you because it’s one of those things that, here we go, you need to educate these people before they meet the patient. 


Jacinta:            Yep.  Yep.


John:               Is it getting any better?  Are the health sectors still labelling people?


Jacinta:            I think it’s getting better.


John:               Great.


Jacinta:            I do, actually.  I think, you don’t read the paper, that’s difficult, it’s hard to read the newspaper.  But there are so many amazing people in our health services that are, you know, they’re not lucky enough to be on a podcast but they’re working their butts off and they’re really trying.  I think, you know, a lot of big hospitals are really putting this population as a priority, community health service is really working hard on this and there’s great programs out there that are really ensuring that these people have better health outcomes.  I think, if you go down that sinkhole of reading the newspapers, listening to the far right, it is quite difficult.  But when you get on the ground and you’re listening to people, I don’t think it’s as bad as what we think it might be.


                        There is still a lot of room for improvement.  And, you’re right, these people don’t want labels, they want to come into Australia, start their new life.  You know, they’ve come to Australia, they don’t want to leave their home, they’ve been forced to go so quickly.  You know, we had one, we’ve had kids that need hearing aids and they forgot to grab their battery as they were leaving the house and the battery doesn’t, it’s not in Australia.  So sometimes, you know, they haven’t had a hearing aid for months because we couldn’t organise the battery and we’re waiting for these aids. 


                        And, you know, these people are getting out of situations that are awful, yeah, and they’re coming to Australia and they want to start their life and they want to be, they want to make friends and, you know, the first thing they ask is, I want a house and I want to learn English so I can get a job.  And if they’re not saying that, we need to make sure that they’re supported and they’ve got the fair quality of care that they deserve. 


John:               That’s where communication comes into it, doesn’t it?


Jacinta:            Absolutely, yeah.


John:               They’ll say things like a hearing aid or, …


Jacinta:            Yeah.


John:               … get all of that medication.


Jacinta:            Yep.


John:               Jacinta, it’s been a fantastic conversation.


Jacinta:            Thanks.


John:               Thank you for coming on board to the Communicate program.  Zen, well done.  I’ve enjoyed it.  For people that would like to listen to other Communicate programs, please go to our website, that’s, that’s our website.  And thanks for listening.  Thanks Jacinta, thanks Zen. 


Zen:                 Thank you Jacinta.


Jacinta:            Thanks John, thanks Zen. 


Zen:                 Thank you so much.


Jacinta:            Thank you. 



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