Local case study – Mid North Coast Local Health District

Coffs Harbour Refugee Health Clinic

1 Oct 2022 Reading time approximately

A nurse-led service introducing newly arrived refugees to health services in NSW.

Location of servicesCoffs Harbour
Patient demographicsAfghanistan, Burundi, Congo, Eritrea, Ethiopia, Iraq, Liberia, Myanmar (Karen and Chin speakers), Sierra Leone, Sudan and Togo.

Information processesInformation is uploaded into the electronic medical record.

Governance structureThe clinical nurse consultant who manages the service is part of the North Coast Population and Public Health (directorate) of the Mid North Coast Local Health District (MNCLHD). The clinical nurse consultant reports to the director of public health.


The Coffs Harbour Refugee Health Clinic offers all new humanitarian entrants a comprehensive health assessment within one month of arrival. If a person is on a health alert or unwell, the health assessment will be conducted immediately or earlier within the timeframe. Assessments are conducted in a culturally competent and safe environment.

Consistent process

Newly arrived people from refugee backgrounds receive ongoing healthcare from nurses. They can attend a dedicated general practice clinic run by the refugee service.

Staff use an interpreter during all consultations and ensure patients feel valued and heard.

Having a clinical space to work in with trained staff, including good clerical support, ensures easier access for clients. It also enables nurses to limit the amount of administration required to support the clinic.

The service can access non-emergency, health-related transport services for families from a refugee background who have mobility issues or who need to access health appointments out of the area.

The team has created a procedure manual that details its operating procedure. This helps to orientate new staff and provide ongoing support and guidance.

You can request a copy of the team's refugee procedure manual using the contact details on the clinic's webpage.

Drop-in times as well as appointments

Ongoing clinic appointments ensure:

  • appointment reminders are reinforced
  • prescribed medication is taken regularly
  • health information is not lost.

There is also a nurse-led, drop-in clinic twice a week. This allows clients to easily see nurses regarding issues such as medication follow up. It helps ensure people don’t go to emergency departments for non-emergency situations.

The Coffs Harbour Refugee Health Clinic team - Pam, Kylie and Michele.

Connecting community

The refugee and asylum seeker community are aware of the refugee health clinic because it has been serving them for 16 years. They often bring recently arrived community members to the clinic.

All new arrivals are referred by the settlement agency.

Clinic staff have also developed strong relationships with staff from:

  • NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS)
  • North Coast Settlement Service
  • Australian Red Cross
  • Uniting Burnside Refugee Parenting Support Program Coffs Harbour and Dorrigo
  • Anglicare Cross Cultural Services
  • Sanctuary Australia Foundation
  • TAFE
  • local schools
  • Coffs Harbour Education Campus.

These relationships ensure information is shared across all services supporting the new community members. It also means the new arrivals are referred to the health service. The local emergency department and other departments within the hospital also refer people to the clinic.

Staff find it rewarding to support people to navigate their health journey. They watch clients become more confident and eventually access the health system without assistance.

Making a difference

The service advocates for all people from a culturally and linguistic diverse background.

Staff appreciate that patients have been through incredibly harrowing experiences in their journey to Australia. They understand that each person is an individual, despite their country of birth, language or ethnicity. They listen to clients and don’t bunch them into a one-size-fits-all group.

Top tips

  • Conduct regular health education sessions using a variety of platforms and venues to help improve health literacy.
  • Run tours of the hospital with interpreters, so patients feel safe and welcomed.
  • It is important to advocate for patients when they are accessing other health services within, and outside, the hospital system.
  • Establish an agreement to access on-site specialists such as a paediatrician, gastroenterologist and haematologist. This will assist when advice is required because it establishes an access pathway.
  • Collect data on occasions of service that include: interpreter usage, where the patient has been seen (hospital, outreach clinic or home), whether via telephone, telehealth or in person. This ensures the patient’s data is not lost should they travel out of the area or move to another location.
  • Have a good relationship with your settlement provider and establish a memorandum of understanding or a similar agreement. This enables you to outline how the services will support each other to meet the common purpose.

Setting up the clinic - Michele's story

The Coffs Harbour area has been involved in refugee settlement since 2000 when humanitarian entrants were initially sponsored by the Sanctuary Australia Foundation.

I became aware of the first families to arrive in Coffs Harbour because one of the people had previously had turberculosis. I was the chest clinic nurse and the person was referred to the clinic as part of their settlement arrangements. From then on, Sanctuary brought all newly arrived families to be re-screened for tuberculosis.

During the next four years, I came to realise the countless difficulties that people faced during settlement. This included navigating the health system, health literacy, health professionals not using interpreters and discrimination. This is not to mention the stress involved in moving to a new country as humanitarian entrants who were forced to flee, rather than migrants who chose to leave their country of origin.

When Coffs Harbour became a settlement site in 2004, there were issues around accessing general practitioners in the area to oversee health assessments. Worried that people would not get adequate health care, I believed that a public health clinic would be the appropriate place. Newly arrived people could get initial health assessments, catch up on vaccinations and get referrals to specialists.

Fortunately, I had a very supportive manager who agreed. So, in collaboration with six local general practitioners, the Coffs Harbour Refugee Health Clinic started in February 2006. Now, all new humanitarian entrants are offered a comprehensive health assessment within one month of arrival or earlier if required. And this is done a safe environment by culturally competent staff.

Michele Greenwood, Clinical Nurse Consultant, Refugee and Multicultural Health, North Coast Population and Public Health (directorate).

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