Settling In Palmerston North and Feilding - Human Rights Commission

in the Settling In discussions and focus groups. One focus group unanimously agreed that access to health services is their biggest concernwhile living here. Students from all countries (except Australia and the UK) need medical insurance to cover all treatments, including doctors,hospitals, ambulance and specialist treatments. 45 Tertiary students can see a doctor at the student health centre on their institution’s campus,usually for a very reasonable fee. However, several issues have been raised in relation to insurance and other matters that cause problemsand stress for students and providers.No Cover for Contraception Advice, Pregnancy or TerminationsThe main concern is that no insurance policy for international students will cover ‘sexual health’, including medical costs associated withcontraception, pregnancy and abortion. There is no Family Planning service in Palmerston North, although the health services at the tertiaryinstitutions are able to provide this information and there are a range of other options for free sexual and reproductive health for under 25 yearolds. For many, however, this subject is not easily discussed and some students may be too embarrassed to bring it up with campus doctors,nurses or others. For those who do get pregnant, there are huge costs to cover (either to continue with the pregnancy or to have a termination)and sometimes there are additional issues of family shame and consequent mental health factors to contend with. Anecdotally, it is reportedthat some international students are known to be importing pills to enable self-abortion (from countries where this practice is legal). For otherstudents, particularly the post-graduates who may be here with a spouse or family, they are at an age when they are naturally producing afamily. It is to be expected that, in the course of the four years when they are here, many will be having their first or subsequent children.However, due to the lack of insurance cover or support and the prohibitive costs associated with pregnancy care, frequently the wife and anyother children will return home for the pregnancy and birth. This is incredibly disruptive and expensive for all family members and usuallyresults in the student having to move into smaller accommodation temporarily and then look for something bigger again upon the family’s returnto New Zealand. The emotional stress involved is very tough for the student and often results in study delays.Perceived Insurance / Entitlement AnomaliesOther students have reported that they are rejected at the hospital for emergency treatment, despite having insurance, because they areunable to pay upfront with cash. Actually this is not the case at MidCentral Emergency where if a patient does not meet the eligibility criteria forpublic health services they will be invoiced after the treatment (usually within the next week). However, payments are required “on the day” foroutpatient appointments (if the patient is identified as a non-eligible patient), but patients are advised about this prior to the appointment. Theissue here seems to be one of communication and misunderstanding about the payment requirements for health services.In addition, some of the longer-term PhD students feel that as many of them work part time and pay taxes while here, as do their spouses (oftenfull time), this should confer a degree of entitlement to health services, such as pregnancy and obstetrics support.Administrative Difficulties and Non-paymentDespite these requirements, the DHB reports that some students do not have insurance cover and are not able to pay their medical coststhemselves, creating ongoing administrative and financial issues for the DHB. In addition, it has been reported that, although technicallyspouses and children also require insurance, sometimes there is confusion about this and they arrive with no cover. Cases of non-paymentalso arise in relation to sexual health matters, such as terminations, which are not covered by insurance.No Cover for Mental HealthMental health issues can also arise for students who are lonely, stressed about study and without family or cultural support. It is suspectedthat much of this goes unreported for a number of reasons, including shame, lack of knowledge about services to help and a lack of insuranceto cover any associated costs.Cultural IssuesSome of the female students report being uncomfortable about seeing male doctors without a nurse present, and complain that some maledoctors do not wear gloves when making physical contact.Focus Group Suggestions• Reconsideration of health entitlements for international students, especially for those working and paying tax and forthose longer-term students with families who may need maternity care while living and studying hereLack of Cohesion/Coordination Between ServicesAlthough there are a number of requirements in terms of pastoral support, English language proficiency and a range of services availablein Palmerston North to help international students, it is perceived that these do not always work together in a way that will promote the bestoutcomes for students. In particular, it has been suggested that a more comprehensive early individual orientation connection (for the studentand any accompanying family members) that assesses actual needs and identifies solutions / delivery opportunities (eg around languageacquisition) would prevent a lot of issues occurring further down the track.SETTLING IN PALMERSTON NORTH AND FEILDINGFocus Group Suggestions• Individual orientation and assessment service for students and families to ensure more cohesive and targetedassistance45According to the Code of Practice for the Pastoral Care of International Students in New Zealand, allinternational students studying in New Zealand must have medical and travel insurance69