Andy arrived in Australia when she was six years old. Her familyoriginated from South Sudan, which they fled due to ongoingconflict. Her parents and older brothers had joined other refugeeson a long walk to Kenya. Many people died along the way due toillness and attacks, food and water were scarce. The family had torely on rations provided by the United Nations. Eventually, thefamily were settled in the Kakuma refugee camp, where Andy wasborn.
When Andy arrived in Australia no one in her family could speakEnglish, and although over time everyone learnt to speak English,it was not the language used at home. When Andy started at school,she understood very few words that were spoken to her. She was veryshy, especially as when she did try to participate in games andactivities, she often did not follow instructions properly and someof the other children made fun of her, calling her “stupid”, andsometimes more hurtful names. There were a few other Sudanesefamilies in the neighbourhood, but none of the children in thosefamilies was similar ages to Andy, and she felt very alone.
Andy’s father Jacob worked driving taxis, often working long hoursto make sure the family could pay the rent and keep food on thetable. When Andy did see her father, he was often tired, however hewould try to spend his free time with her and her siblings. Hersecond oldest brother Martin was a great athlete and playedfootball for the local team. One of Andy’s favourite memories wasoff the whole family going together to watch Martin play and cheerhim on. Even Andy’s mother, Sara, would join in the outing. Saradidn’t leave the house very often, and never alone. Andy knewsomething bad had happened to her mother in the refugee camp, butit was never spoken about. Sara didn’t like Andy to leave the houseeither, except for school and occasionally when one of her brothersor her father would accompany her somewhere. Some of the girls atAndy’s school spoke about having dance classes and clubs that theywere in, but Sara was worried about Andy attending these types ofgroups, and money was tight, so she never got to go.
Andy struggled at school and was placed in remedial classes atprimary school to help her reach an acceptable academic level. Whenshe got to secondary school, she met Roxy who became her closestfriend. Roxy introduced Andy to a whole new world of music, fashionand crushes on T.V stars. Roxy laughed at everything and everyoneand didn’t seem to care about not being good at school or gettinginto trouble from the teachers. Andy and Roxy would skip classesfrom time too time to go hang out at Roxy’s place to watch Netflixor dance. When Andy invited Roxy over to her house, Roxy would saythat she wouldn’t be allowed to go because her parents would thinkthat Andy’s brothers were in a gang, because Sudanese gangs werealways being talked about on the news. However, they would be Okwith Andy coming over to visit her, whenever she wanted. Over timeSara and Jacob noticed that Andy seemed happier and more confidentsince having Roxy as her friend and allowed Andy to visit afterschool and sometimes on the weekend. Eventually this extended toovernight stays as well.
Through Roxy, Andy expanded her group of friends, especially oncethey started going to parties when Andy was having an overnightstay at Roxy’s place. Roxy taught Andy how to smoke, saying that ifyou smoked you could always find people to hang out with. This wasparticularly useful advice once Roxy got a boyfriend who she wouldoften disappear with when they were at parties, leaving Andy alonefor hours at a time. Andy’s new friends understood that it wasdifficult for her to get alcohol and cigarettes, and generouslyshared what they had with her. Andy was grateful for this but beganto resent her family being different from everyone else’s. Whenthey were 16 Roxy began to worry that they were putting on too muchweight and thought it would be good to switch their party alcoholwith ice instead. She warned Andy that she would have to get a jobor find some other way to pay for her own supply, as everyonecouldn’t keep helping her out.
Sara and Jacob became worried about Andy, when they noticed she waslosing weight, was sometimes happy and cooperative and at othertimes angry and aggressive at home. She appeared to be getting intotrouble at school more and they were contacted several times abouther missing classes or being disruptive in class. They triedtalking to with her, giving her extra responsibilities at home andgrounding her. Often Andy would simply leave the house angry oreven climb out window when they tried to keep her in her room aspunishment. In desperation they went to discuss their concerns withthe Minister at their church, who suggested that Andy might needprofessional counselling. He assisted Sara and Jacob withcontacting Headspace, the local youth mental health service whichoffered free counselling. They were told that they would be happyto see Andy for an appointment in 6 -8 weeks, however Andy had tomake the appointment for herself, her parents couldn’t make it forher.
When Sara and Jacob tried to talk with Andy about seeing acounsellor at Headspace, she became very angry with them, saying itwasn’t her that needed counselling, but them. Not knowing how tomanage the situation Andy’s parents decided not to push the issueany further at the time. Two weeks later Andy ‘ had an argumentwith Roxy ending their friendship. Andy’s brother Martin found herwith self-inflicted deep Andy was hospitalised for several days.She was assessed and later diagnosed as having bipolar disorder.Andy was prescribed medications that her parents are struggling topay for. After the initial regular visits with psychiatricservices, Andy is now managed by her GP, as she will provide theseat the Medicare rebate rate, and Andy can access 10 freepsychologist visits for the year organised by the GP with thepotential for a 6-month extension. Sara and Jacob are unable toafford to access any sessions privately.
1. A detailed explanation of what is meant by the socialdeterminants of health is provided. • Identification of all socialdeterminants with the potential to influence the health of thecharacters in the case study are identified. • How and/or why thesesocial determinants influence the health of the characters in thecase study are synthesised in a detailed discussion.
2. A clear and succinct explanation of health equity has beenprovided. • Enablers and barriers to health equity have beenassessed. Good links to the characters in the case study areestablished in the discussion.
3.A clear and succinct explanation of the Ottawa Charter isprovided. • The five areas for action or strategies for healthpromotion activity outlined in the Ottawa Charter are succinctlyexplained. • A clear and detailed plan to address one of the socialdeterminants identified in the case study is presented. The planengages three of the five areas for action or strategies for healthpromotion. • The plan demonstrates a thorough understanding of thestrategies selected (1500 words)
