Healthcare for All! Hurdles for overseas visitors who use drugs

NUAA'S peer support program for people who are on pharmacotherapy and who have hepatitis C has been very successful. Many people have been tested and treated with the support of a NUAA worker. NUAA works with services respectfully to increase testing and treatment take up among their patients.

Nik is Nepalese Australian and works for NUAA in two different clinics. People from overseas may face particular challenges seeking health care such as hepatitis C assessment, treatment and care. Nik finds working with these people one of the best parts of his job. Here are some words from Nik and stories from two of the people whose lives he has touched.

Nik says

Most of the people I see from overseas are young - in their 20s. They are often from small countries and have come to Australia to study, looking for a better life. Others are stateless: refugees awaiting official status or overstayers. Some of them used overseas and may have come here to get away from a habit, however started using again to cope with the stresses of survival in a new country with a new language and customs, away from family and everything familiar. Others only began using drugs once they came to Australia, like many young people do when they find themselves independent and away from family. They often can't return home because of the stigma of using in their home countries and consider it impossible to reveal to their parents their drug use. They are usually in financial crisis.

These people face barriers in getting health care. Apart from language issues and concerns about confiding in medical staff, they may not have enough identification to get on a pharmacotherapy program or be tested or treated for HIV or viral hepatitis. Even if they have a visa, they do not have a Medicare card for seeing a doctor and getting health care.

Most of the people who ask me for help think they have acquired hepatitis C here in Australia. They have little information in their language about harm reduction and safer injecting and don't know where to find sterile injecting equipment, perhaps assuming that laws around acquiring equipment were the same as at home.

In helping people to overcome the barriers of language, lack of information and lack of resources to connect with health care, part of my job has been to research places where people can get tested and get a Fibroscan and even treatment without a Medicare card and I refer them there and set up appointments for them. It is my greatest pleasure to be able to help all people access healthcare and give them a new start and a new emphasis on their lives. For these people who have particular barriers to hurdle, I feel a great joy and achievement when I can help them get the health care that they deserve.

Sabin's story

This is my story. I am a young Nepalese man, an overseas student, who came to Australia aspiring for a better life. Like many other young guys, I was a user in my own country. Coming to Australia, away from my parents and everyone I knew proved to be both exciting and sad at the same time. I was free to do whatever I wanted with my life! Although I found I had to study and work a lot more than I had ever imagined.

With the stress of study and work life, and also making new friends, somehow I found myself hanging out with people with a history of using drugs. At one point of time, I found myself sharing a needle with one of my mates. Little had I known that this mate had been sharing needles with another guy who already had hepatitis C.

I was devastated to know that I got hepatitis C. I felt as if it was the end of my life. But, as they say, the best things in life come when they are least expected. Somehow, I made my way to a pharmacotherapy clinic as a casual visitor where Nik worked. I was so glad and overwhelmed to know that he was a Nepalese too. Finding someone I could openly talk to about my life and drug use was such a relief for me. After knowing all about my situation and my financial crisis, Nik went out of his way to find me a clinic and provided me with treatment facilities, without me having an Australian Medicare card. He set up my hepatitis C treatment with a great nurse at a kind service. So far, I have not officially started the treatment, but have undergone the blood sampling and all. I will soon start with the hepatitis C treatment process.

After making a mistake that could cost me my life, I have finally realised that life is not all about this. Life is beautiful only when you try to see it beautiful. For me, part of seeing the bright side of this life is when I can talk to people from NUAA who understand and the huge relief I feel that I am able to get treatment for my hepatitis C and care for my health.

Hyo's story

I am in my early 20s and now I am legally in the country with a proper visa. I am a uni student studying hard. I am on methadone at a clinic. I am doing well.

But when I first came to Australia to study, I began to use heroin. I had only been using for about three months when I wanted to stop. I couldn't do it on my own, I realised I needed some treatment. The trouble is, when you are an overseas student and you start using drugs, you stop everything, you just focus on using. Everything else goes by. I didn't go to school and I failed so of course I lost my visa. Then I became an illegal overstayer. There are lots like me. All we can do is keep using and keep getting money somehow. I went on for over a year as an overstayer, just using, and not wanting to. I didn't know what to do.

Usually the only chance for overstayers to receive an Australian visa of any kind is to leave Australia and apply again from overseas. However, this is very difficult as you will get a three years period of 'unable to enter Australia'. You can apply for a waiver of the ban through an Australian consulate overseas, but this is rejected except for very strong reasons. Coming back to Australia for the treatment of addiction is not considered at all.

I couldn't go home to Korea or China, because there is no treatment there. There is little methadone. There is no compassion. If they find out you are a user, at the worst it's execution in China and at the best, in Korea it's imprisonment. And I couldn't let my family know. I really wanted treatment and I was in a real bind. I didn't have a valid visa, so I couldn't get treatment in Australia. I wanted to quit but I couldn't.

The alternative chance I thought was to go to an overstayer facility and get treatment there. When I called them asked if this is possible, they said they can provide any necessary treatment for me including methadone or buprenorphine treatment. So I made the decision to do that, to go into the facility and get treated there.

I couldn't believe how awful it was in there. I love Australia and Australians and I couldn't believe there was such a place here. I felt I had no rights and was treated like an animal, that they could do whatever they liked.

I had been in the facility for four days very sick before I even got to see a doctor. I had been led to believe they would put me on a treatment program. They did nothing. A doctor eventually saw me and he gave me two valium. I felt he didn't care how ill I was. I think they didn't want to put me on methadone as it might form grounds for me to stay in Australia. I was so ill, banging my head on the wall, crying. Eventually they gave me a week on buprenorphine. During that week they gave me methadone twice instead of buprenorphine. I asked why, they said it is the same thing, don't worry. But the methadone made me very ill on top of the buprenorphine. They didn't say sorry, they just insisted it was the same thing. I was still sick and agitated. I begged to see a doctor, but they kept ignoring me. I could not eat and was dehydrated badly; I lost about ten kilograms. I asked for vitamins but was refused.

Eventually I got a lawyer, who organised a bridging visa for me for two months with strict departing grounds. I went straight to Clinic 36 and got on a methadone program. I was so relieved. Then I went back to see Immigration. I explained why I had become an overstayer and asked to stay in Australia til I finished my treatment. They knew my history and compassionately decided to give me another chance. They could see I was sincere. I am required to see them monthly. So I have a visa again. I am back at uni studying very hard.

Without a visa, without a Medicare card, as an overstayer, it was impossible for me to get health care like detox, methadone or hepatitis C testing. And there are many people like me. Until I could get this part of my life sorted, I couldn't sort out anything with nutrition and other health issues. I now need to make sure I don't have hepatitis C. I was careful not to share needles so I believe I haven't got hepatitis C, but I need to make sure.

I cannot express the peace of mind I feel to be able to focus on my health. It is a big relief to know that I can get access to a test for hepatitis and be treated if I need to. As an overstayer, I could not access any of those health care services. They really have to figure something out for overstayers who need health care very badly, like pharmacotherapy and treatment for blood borne viruses. Everyone deserves health care, no matter where they find themselves in life or in the world, whatever their circumstances.