Finding refuge

Dr Mitchell Smith took a working holiday overseas and found himself venturing into new medical territory

Refugee health services didn’t exist in Australia when Dr Mitchell Smith began his medical career, but a working holiday in Europe in the 1980s changed all that.

When the former emergency department doctor went knocking on doors in Paris in search of a job, the first door that opened led to a new path in medicine.

The job, with an aid organisation in Peshawar in northern Pakistan, involved teaching Afghan medics who would return home to practise as barefoot doctors.

“Our patients were refugees living in dusty camps and we’d arrive in a van and set up clinic under a tent or in a mud hut”, says Dr Smith, who is now director of the NSW Refugee Health Service in Sydney.

In those early days, he says, his motives were not especially altruistic. Inspired by trips to developing countries such as Egypt and Turkey, he wanted to immerse himself in cultures different to his own.

After 9 months in Peshawar, he joined Médecins Sans Frontières (MSF) in Hong Kong, this time working with Vietnamese refugees.

“Things were very different there, working in a developed territory”, he says. “We’d catch public transport with the suited execs on their way to work but, unlike them, we’d end up in a massive detention centre, all concrete and fences, or a refugee camp that smelt of rotting garbage.”

Dr Smith initially worked as a clinician with MSF, but he was the only staff member whose first language was English so he soon became the medical coordinator of the program. It was not an easy gig.

“That was my first taste of management”, he says. “I had no training and I was negotiating with Hong Kong government authorities and the United Nations High Commissioner for Refugees, and managing staff who were working under difficult conditions — all in a politically charged and stressful environment.”

Dr Smith acknowledges that though he didn’t set out to save the world, his early experiences overseas changed more than just his professional direction.

“They also affected my attitude and approach to people, particularly patients, and taught me a lot about social justice, human rights abuses and compassion”, he says.

It also showed him that people’s circumstances could profoundly affect their health, so he headed back to Australia to do a Masters of Public Health.

After completing his Masters degree in 1993, Dr Smith again worked with refugees, this time with the NSW Refugee Screening Program.

“It was probably the only refugee health job in Australia at the time”, he says. “It just didn’t exist as a field back then, and NSW was one of few states that had refugee screening.”

After a number of years, discussion began about a new health services delivery model to help refugees — in particular those who had just arrived — with their health needs.

Thanks to his overseas experience, Dr Smith was included in those talks and was later involved in planning the new unit, which is now known as the NSW Refugee Health Service.

The service gained funding from NSW Health in 1999, and Dr Smith was chosen to head it, a role in which he has continued to push for improvement in the health of refugees.

While the health issues facing different refugee groups vary, there are many similarities, he says.

“Psychological health problems are common, as are infectious diseases such as chronic hepatitis B, and vitamin D deficiency. We also see lots of dental problems, anaemia and chronic diseases like diabetes.”

Dr Smith says a lot of the psychological problems heal with time if refugees feel welcome, safe and secure, and find employment. “They are the most important things for healing.”

He says many refugees survive horrendous experiences and later become productive and effective workers.

The NSW Refugee Health Service is often able to employ refugees, such as in community education roles. “It’s satisfying to give them employment and watch them blossom. Often they move on to bigger and better things in terms of employment — we see ourselves as a stepping stone for them.”

Dr Smith says part of his role includes advising on policy matters at state, national and international levels. He sits on a group that advises on public health issues in detention centres, and he chairs the Refugee Health Network of Australia.

Dr Smith has been involved in other public health work. In 2009 he joined an advance team of staff who flew to Western Samoa immediately after the tsunami.

“I was driven around the island to view affected areas, and we visited people who were living under sheets of plastic in the hills. It brought back echoes of the refugee camps. Even though this was a natural disaster, these people were facing similar issues.”

Dr Smith still draws on his overseas experiences that go back two decades.

“I’ve had a huge variety of experiences in this field and have lots of memories — some are traumatic, others are really warming”, he says. “I’ve seen survivors of torture who’ve been enormously affected by that, but those same individuals have gone on to successful employment, started families, and that’s really satisfying to see.

“It’s absolutely shaped me, not just professionally but also personally. You don’t work in those settings without it changing you.”