AKT – Migrant, refugee and asylum seeker health

Fatima Al-Karim, aged 35, recently arrived in Australia as a refugee from Syria, presents for a general health check. She reports feeling tired and has noticed occasional palpitations. She is unsure of her immunisation history.

She has no known allergies, is not on any medications, and is living in temporary accommodation with her husband and two children.

On examination, she appears well, with a heart rate of 88 bpm and BP of 112/72 mmHg. Cardiovascular and respiratory examinations are normal. Blood tests reveal Hb 98 g/L (NR 115–165), MCV 72 fL (NR 80–96), ferritin 8 mcg/L (NR 20–200).

What is the MOST appropriate next step?

Rohullah Quraishi, aged 28, recently arrived in Australia from Afghanistan. He presents with a persistent cough for 3 weeks, night sweats, and 4 kg weight loss. He denies haemoptysis. He is living in community detention and has not accessed healthcare in over a year.

He is afebrile, respiratory rate 18, and oxygen saturation 98% on room air. Chest auscultation reveals crackles in the right upper zone.

What is the MOST appropriate initial investigation?

Amina Ibrahim, aged 21, presents for contraceptive counselling. She arrived from Somalia 6 months ago and has limited English. Her older sister is translating. Amina appears withdrawn during the consultation and avoids eye contact. She discloses a history of female genital cutting when asked directly.

She does not have a regular partner and is not currently sexually active.

What is the MOST appropriate initial approach?

Nguyen Tran, aged 52, is a Vietnamese man who migrated to Australia 4 years ago. He presents for a check-up. He has no symptoms but is concerned about hepatitis B, which affected a relative.

He is unsure of his vaccination status and has not seen a doctor in many years.

What is the MOST appropriate next step?

Leila Rezai, aged 8, has recently arrived in Australia with her family as asylum seekers from Iran. Her parents are concerned about her behaviour, reporting increased anxiety, nightmares, and clinginess since arriving. She attends school but struggles to concentrate.

There is no history of trauma or abuse since arrival. She is otherwise healthy.

What is the MOST appropriate next step?

Mohammad Al-Rashid, aged 46, presents for follow-up after recently being granted a permanent protection visa. He has hypertension and type 2 diabetes, diagnosed overseas. He reports difficulty managing medications due to cost and language barriers. He is currently unemployed and lives with extended family.

BP 152/94 mmHg, HbA1c 8.6%. He is taking metformin 500 mg twice daily and perindopril 5 mg daily, inconsistently.

What is the MOST appropriate next step?

Thuy Nguyen, aged 30, is a Vietnamese woman who presents requesting a pregnancy test. She is unsure how far along she may be. She arrived in Australia 3 months ago as a student and speaks limited English. She is visibly anxious and accompanied by a male partner who answers most questions.

On examination, she appears withdrawn. A urine pregnancy test is positive.

What is the MOST appropriate next step?

Khalid Hassan, aged 39, is an asylum seeker from Sudan who presents with sleep disturbance and poor concentration. He has experienced nightmares and hypervigilance since witnessing violence before his migration. He avoids talking about these events. He declines medications, saying he wants to manage “naturally”.

There is no suicidal ideation. He lives with his cousin and is not working.

What is the MOST appropriate initial management?

Rania Haddad, aged 28, is a refugee from Lebanon attending your clinic for the first time. She requests STI screening but is concerned about confidentiality. She is not currently sexually active but has had multiple partners in the past. She is unsure what tests she needs.

She is otherwise well and takes no medications.

What is the MOST appropriate next step?

Abdi Yusuf, aged 17, recently arrived in Australia from Somalia. His mother brings him in due to concerns about poor school attendance and recent arguments at home. He has become withdrawn, spending most of his time alone. He denies suicidal thoughts.

He speaks English well and has no significant medical history.

What is the MOST appropriate initial management?

Nasrin Rezaei, aged 42, presents with new onset fatigue and dizziness. She migrated from Iran 2 years ago and has not had medical care since arriving. She follows a vegan diet and denies any medications or supplements.

On examination, she appears pale. Her blood pressure is 110/68 mmHg, and heart rate is 88 bpm. Blood tests show Hb 94 g/L, MCV 106 fL, and serum B12 of 120 pmol/L (NR 140–650). Folate and iron studies are normal.

What is the MOST appropriate next step?

Ali Mohamed, aged 50, presents with concern about memory decline. He is a refugee from Iraq and has experienced torture and imprisonment in the past. His wife reports irritability and poor sleep. He avoids social contact and startles easily.

Cognitive screening with the RUDAS suggests borderline performance.

What is the MOST appropriate initial next step?

Sadia Ahmed, aged 23, attends for advice about cervical screening. She arrived from Pakistan 1 year ago. She is sexually active but has never had a Pap smear or HPV test. She is concerned about pain and wants to know if it is really necessary.

She has no symptoms and no relevant medical history.

What is the MOST appropriate next step?

Dragan Petrovic, aged 62, is a newly arrived refugee from Bosnia who presents with poorly controlled hypertension and occasional headaches. He brings a handwritten list of past medications, including atenolol and ramipril, which he has not taken in 2 months due to supply issues during travel.

His BP is 168/102 mmHg. ECG shows LVH.

What is the MOST appropriate next step?

Samira El-Amin, aged 31, attends for a travel medicine consultation before returning to Sudan to visit family. She has lived in Australia for 6 years. She is 12 weeks pregnant and plans to stay for 2 months in a rural area.

She is up to date with routine vaccinations and has no significant past medical history.

What is the MOST appropriate advice?

Reza Moghaddam, aged 67, presents for a health assessment. He recently arrived in Australia under a family reunion visa. He has no prior records. He is unsure of past vaccinations but recalls a history of tuberculosis exposure in his youth.

He has no respiratory symptoms. Examination is unremarkable.

What is the MOST appropriate screening test?

Fatoumata Diallo, aged 38, is an asylum seeker from Guinea who presents requesting contraception. She speaks limited English and attends with a community worker. She is unsure what methods are available and expresses a desire for something long-term.

She is G4P4, not currently in a relationship, and has no chronic illness.

What is the MOST appropriate contraceptive option to offer initially?

Ahmed Ibrahim, aged 29, presents with chronic epigastric discomfort and bloating. He migrated from Egypt 18 months ago. He denies weight loss, vomiting, or GI bleeding. Examination is unremarkable.

He has never been tested for Helicobacter pylori.

What is the MOST appropriate initial investigation?

Yen Phan, aged 44, is a Vietnamese woman with type 2 diabetes who has missed several follow-up appointments. She tells you that she feels overwhelmed and doesn’t fully understand her condition. She speaks basic English and is accompanied by her adult daughter.

She currently takes metformin but is unsure of the dosage. HbA1c last month was 9.2%.

What is the MOST appropriate next step?

Abdul Rahman, aged 51, presents with low mood and anhedonia. He has a history of forced displacement and time in a detention centre. He has no suicidal ideation but expresses hopelessness and difficulty sleeping.

He has no past psychiatric history and takes no medications.

What is the MOST appropriate initial management?

Faridah Kamara, aged 34, is a refugee from Sierra Leone who presents for a general check-up. She is asymptomatic but concerned about HIV due to past trauma. She is unsure of her status and has never been tested.

She is married and has two children. She denies current sexual risk factors.

What is the MOST appropriate next step?

Abdirahman Isse, aged 15, recently arrived from Somalia with his family. He attends with his mother, who is concerned about poor school performance and tiredness. He has no fever or weight loss. Blood tests show Hb 102 g/L, MCV 68 fL, and elevated lead level.

He lives in older public housing and consumes traditional herbal remedies.

What is the MOST likely cause of his anaemia?

Tran Thi Huong, aged 58, recently arrived from rural Vietnam and presents for a health check. She has no medical records. Examination is normal. She reports exposure to untreated water sources in the past.

What is the MOST appropriate infectious disease screening to include?

Hassan Al-Najjar, aged 47, is a refugee from Iraq who presents with symptoms of gastro-oesophageal reflux. He has been using over-the-counter antacids with partial relief. He smokes and drinks coffee regularly.

He has no weight loss, vomiting, or dysphagia. Examination is normal.

What is the MOST appropriate initial management?

Zainab Yusuf, aged 6, recently arrived in Australia on a humanitarian visa. Her mother brings her in for a general check-up. She has had no vaccinations documented. She is well and developing normally.

What is the MOST appropriate initial management?

Aliya Khan, aged 26, presents requesting a mental health care plan. She is a refugee from Afghanistan, recently diagnosed with PTSD by a psychologist. She feels overwhelmed and tearful most days, though has no suicidal ideation. She is keen to access counselling but unsure how to proceed.

What is the MOST appropriate next step?

Mohammed Said, aged 60, presents with chronic cough. He arrived in Australia 3 years ago from Somalia. He has smoked for 40 years. Examination reveals scattered wheezes and prolonged expiration. Spirometry confirms FEV1/FVC ratio of 0.65, FEV1 55% predicted.

What is the MOST appropriate diagnosis?

Jianhua Li, aged 32, presents for advice on managing hepatitis B. He was diagnosed during a health screen after migrating from China. He is asymptomatic and has normal LFTs and low viral load. HBsAg is positive, anti-HBc is positive, HBeAg negative, anti-HBe positive.

What is the MOST appropriate next step in management?

Marwa El-Khatib, aged 29, is a recently arrived asylum seeker who is 14 weeks pregnant. She has had no antenatal care so far. She is uncertain about her immunity to rubella and varicella. She is otherwise well and has had no complications.

What is the MOST appropriate next step?

Ismail Nour, aged 20, recently arrived from Eritrea. He reports feeling isolated, struggling with English and having difficulty finding work. He denies depression or suicidal thoughts but feels ‘worthless’ and has little social support. He is otherwise healthy.

What is the MOST appropriate initial approach?

Layla Abdi, aged 33, presents with a 3-week history of joint pain affecting her hands and wrists. She arrived in Australia from Somalia 6 months ago. She has morning stiffness lasting over an hour and swelling in the MCP and PIP joints bilaterally.

She has no significant medical history and takes no medications.

What is the MOST likely diagnosis?

Ngoc Le, aged 24, presents to establish care as a new patient. She arrived from Vietnam on a student visa. She has no regular GP and is unsure of her immunisation history. She works part-time in a childcare centre.

What is the MOST appropriate initial action regarding immunisation?

Yusef Al-Mansoori, aged 45, recently arrived in Australia from Iraq. He presents with mild right upper quadrant discomfort. He has a history of hepatitis C diagnosed overseas but has not had any treatment.

He feels well otherwise. LFTs show mildly elevated ALT. HCV RNA is detectable.

What is the MOST appropriate next step in management?

Mina Yosef, aged 19, presents for a health check. She arrived from Egypt as a refugee and is living in shared accommodation. She has no symptoms but is concerned about blood-borne viruses. She has no history of injecting drugs or transfusions.

What is the MOST appropriate set of screening tests to offer?

Habib Rahimi, aged 40, is a newly arrived refugee from Afghanistan. He presents with difficulty sleeping, poor appetite and persistent worry about his family overseas. He has no history of mental illness and denies suicidal ideation.

He is currently living in temporary accommodation and is unemployed.

What is the MOST appropriate initial management step?

Noura Saad, aged 31, presents for her first antenatal visit. She recently arrived from Syria as a refugee. She is 10 weeks pregnant. She is unsure of her immunity to infections in pregnancy and has had no prior antenatal care.

What is the MOST appropriate initial antenatal screening test to include?

Rashid Karim, aged 48, presents for follow-up after a positive Quantiferon Gold test. He is originally from Afghanistan and arrived in Australia 2 years ago. He is asymptomatic and his chest X-ray is normal.

What is the MOST appropriate next step?

Le Thi Mai, aged 62, presents with generalised fatigue and occasional palpitations. She migrated from Vietnam 5 years ago. Examination is normal. ECG shows atrial fibrillation with a ventricular rate of 84 bpm. CHA₂DS₂-VASc score is 3.

What is the MOST appropriate next step in management?

Djamila Ibrahim, aged 38, presents with low mood and fatigue. She is a refugee from Sudan and has been in Australia for 3 years. She is not working and lives in public housing with her two children. Blood tests reveal Hb 106 g/L, MCV 72 fL, ferritin 10 µg/L.

What is the MOST appropriate first-line management?

Hussein Al-Maari, aged 50, presents with poorly controlled type 2 diabetes. He migrated from Iraq 4 years ago. He has difficulty understanding medication instructions in English and has missed several diabetes education sessions.

HbA1c is 9.8%. He is on metformin and gliclazide.

What is the MOST appropriate next step?

Aziz Al-Hakim, aged 42, is a refugee from Syria presenting with chronic lower back pain for the past 6 months. He denies red flag symptoms. He is unemployed and has limited access to allied health due to financial constraints.

What is the MOST appropriate initial management?

Samira Youssef, aged 36, presents with general fatigue and menstrual irregularities. She arrived from Lebanon 2 years ago. Blood tests show TSH 8.2 mU/L (NR 0.4–4.0), with low-normal free T4. Anti-TPO antibodies are positive.

What is the MOST appropriate management?

Daniel Tesfaye, aged 54, presents with difficulty sleeping and frequent nightmares. He is a refugee from Ethiopia and experienced trauma before arrival. He avoids reminders of the past and feels emotionally numb.

He is otherwise physically well. He has never accessed mental health care before.

What is the MOST appropriate next step?

Amal Hossain, aged 22, is a university student from Bangladesh on a temporary visa. She presents with symptoms of dysuria and increased urinary frequency. She is sexually active and has no fever or flank pain.

Urine dipstick is positive for nitrites and leukocytes.

What is the MOST appropriate management?

Nguyen Van Hao, aged 66, presents for a routine check. He migrated from Vietnam 5 years ago. He has a 40-pack-year smoking history but has never been screened for lung cancer. He is asymptomatic.

What is the MOST appropriate action?

Zahra Ali, aged 7, recently arrived from Iraq as a refugee. Her mother is concerned about Zahra’s difficulty hearing at school. She has no pain or fever. On otoscopy, her tympanic membranes appear dull with reduced mobility bilaterally.

What is the MOST likely diagnosis?

Abdi Warsame, aged 28, presents with concerns about infertility. He and his wife have been trying to conceive for 2 years. He arrived from Somalia 3 years ago. He reports no erectile dysfunction or STIs. Examination reveals normal secondary sexual characteristics but small testes.

What is the MOST appropriate initial investigation?

Fatima Noor, aged 55, recently arrived from Afghanistan and presents with chronic pruritus, particularly at night. She has excoriated lesions on her wrists and between her fingers. Her grandchildren, who live with her, have similar symptoms.

What is the MOST likely diagnosis?

Aung Ko, aged 33, presents with a chronic cough and malaise. He is a refugee from Myanmar. He has no weight loss or haemoptysis. A chest X-ray shows a right upper lobe cavitating lesion.

What is the MOST appropriate next step?

Leah Okeke, aged 27, is a refugee from Nigeria presenting for a cervical screening test. She is unsure of her vaccination history. She has had two sexual partners and no previous Pap smears.

What is the MOST appropriate action?