Transcript of Hearing - BRISBANE
Monday 5 August 2002
Please note: This is an edited transcript
DR SEV OZDOWSKI, Human Rights Commissioner
MRS ROBIN SULLIVAN, Queensland Children's Commissioner
PROFESSOR TRANG
THOMAS, Professor of Psychology
Royal Melbourne Institute of Technology
MS VANESSA LESNIE, Secretary to the Inquiry
DR OZDOWSKI: I would like to formally open this public hearing which is one of a series of hearings conducted around Australia and I think it's possibly the last one which involves the public. We will have further hearings for Immigration officials and ACM officials. My name is Sev Ozdowski and I am the Human Rights Commissioner of Australia and I have two Assistant Commissioners assisting me with this Inquiry.
On my right is Professor Trang Thomas, Professor of Psychology at the Royal Melbourne Institute of Technology and on my left Mrs Robin Sullivan, who is also the Queensland Children's Commissioner. Before the hearing commences I would like to note the following matters. First, the issue of confidentiality and privacy. The Commission believes it is important to respect the privacy of individuals and to protect children in particular. Even where individual cases have been made public elsewhere, individual's names should not be named in this hearing.
And as a matter of fact I issued a number of directions to protect the security and privacy of people and the effect of these orders is that the identity of Mr X is not to be disclosed during the hearings. Second, that the identity of any other person who requests anonymity is not to be disclosed. And third, that the identity of any third parties is not to be disclosed and this includes current or former employees at detention centres and these people shouldn't be named because they have not had the opportunity to defend themselves against allegations which could be made.
I therefore also would like to ask the media to adhere to the following: that when witnesses request not to be identified by name or photograph even though they may have given public evidence, please respect this request. When filming please respect the wishes of those who may not want to be included in any background shots. Now, I would like to invite our first witness, Mrs Jane Delaney-John from Access Childcare Equity Supports Program. Welcome to the hearings.
MRS J. DELANEY-JOHN: Thank you.
DR OZDOWSKI: The role of the Commission is to test evidence which was provided in the submissions and to elicit further information, so I will ask you a number of questions and also my Assistant Commissioners will do the same. And if you feel that you don't understand the questions just please ask. I will try to rephrase them, but to start with I would like to ask you to take an oath or affirmation and I will ask Ms Vanessa Lesnie, who is Secretary to the Inquiry, to administer it.
MRS J. DELANEY-JOHN: Just the affirmation, thank you.
JANE DELANEY-JOHN [8.34am]
Diversity in Child Care, Queensland Access Program
DR OZDOWSKI: Thank you. Now, could I ask you for the record to
give your name, address, qualifications and the capacity in which you
are appearing?
MS DELANEY-JOHN: My name is Jane Delaney-John and I'm the program manager of the Access Program, which is a program of Diversity in Child Care, Queensland. My home address is [address removed]. I am early childhood trained, with more than 10 years' experience working with refugee children and migrant children in the inclusion needs of those children into child care services.
DR OZDOWSKI: And now I would like to remind you again about the orders I made about privacy. If you would like to mention some names, please provide them to the Secretary to the Inquiry after the hearings. Sometimes it may be necessary to do so in order so we can follow through documentary material to establish what the full circumstances of individual cases are. Now, could I ask you to make an opening statement and in particular I would like to ask you to say something about the children's services you are providing and what we are particularly interested in are kids on TPVs with whom you have contact. We would like to establish the level of your expertise with children on TPVs.
MS DELANEY-JOHN: Okay. Access is a Commonwealth-funded supplementary service program and our main charter is to support families to access children's services of their choice, Commonwealth-funded children's services of their choice, and to support child care services in the inclusion needs of children into those care arrangements. Those care arrangements can be ongoing support over a period of time, depending on the individual needs of children so some can be shorter periods of time and others can extend for more than 18 months of support or beyond.
With the children that we've provided support in the last year we have provided support for children from all migration status, but within that there has been 99 children who are refugee children and there are 45 children who are actually temporary protection visa. In addition to the support provided within the children's services, there are home visits that take place where there's observations of children that take place, and also we have a subcontract where we've actually been providing the creche situation for the children at Harmony Place, the ethnic mental health, where staff have actually been looking at the inclusion needs of children and providing a creche play environment for those children.
DR OZDOWSKI: So if I understand correctly, you are basically a referral service to various child care services providers and you are financed by the Commonwealth.
MS DELANEY-JOHN: Yes, but in addition to that we actually look at the inclusion needs of the children; what is actually happening in the range of behaviours, what are the linguistic needs of the children, what are the cultural and spiritual needs of the children and are there other stressors or traumas that might actually be not conducive to sound development for children, and it's actually about upskilling and giving the staff confidence to be able to create those bonds and relationships with the children and their parents and also to look at the daily care needs of those children.
DR OZDOWSKI: What ages of children are you dealing with?
MS DELANEY-JOHN: We cover the age of birth through to 13 years of age.
DR OZDOWSKI: Could you say something about your experience with the 45 kids who were TPVs and especially you mentioned in your submission that there are a number of behaviours which were of concern to you. Could you perhaps say a bit more about that?
MS DELANEY-JOHN: Okay. While I think it's fair to state that the ranges of behaviours that I'm presenting today we have seen in evidence for children who are refugee children, one of the factors which I think bears some heightened examination is that for the children who are refugee experience, we've provided 140 hours to 16 hours of inclusion support, depending on the needs of children, compared to the children who are TPVs, which is 200 hours to 30 hours. Also, the elongated levels of distress that occurs with the children. With the behaviours of the children, sleeping difficulties where babies are waking because they are crying, not that they're actually waking and then crying, is quite readily observed. Children taking a long time to settle and then sleeping lightly and they're quite watchful and afraid to go to sleep within the services and some of the children are exhibiting signs of rocking continuously. The period of time in which that has actually been occurring has been quite extended.
Now, while there has been some reduction in these behaviours while children have been bonding, the length of time really is what we'd like to note, and there are four children particularly who appear to wake up and appear sad. They have slumped features and stance and have no interest in actually participating or moving around and continue to show those kinds of signs and behaviour. There are some over-dependent behaviours and they have a high level of autonomy so they are not actually interacting in a co-operative way. They seem to value the autonomy in the way that they're behaving.
What we've noted particularly is that children are constantly watchful of others and also visitors to any services and situations. This has been observed both within services and within home visits, even though we might have made repeated visits to those homes and made relationships with families. There are some levels of aggression in the children aged from four to seven years particularly and while that might not be considered for some children, to have some aggressive tendencies, in three of the children aggression was observed at times when children returned from outdoor play and only at these times.
So when we're looking at the individual needs of children with aggression, we try to observe the periods of time in which children are much more challenging, and we try and actually work out those times that we actually can see how we could modify environments of approaches and those sorts of things. So it actually was quite interesting that - the children were actually being observed as they were coming from the outdoor play to the indoor play; there was some aggressive tendencies occurring then. There's some withdrawn behaviours to children, and children particularly not wanting to be touched, and also some excessive hiding, where children are continually looking for little hidey holes, and having to spend quite some time developing programs where children can actually, you know, play where they're remaining and encourage them to participate in the broader environment.
And while it's agreed that these behaviours can be observed in refugee children, the number of children in the cohort of claimants is higher where behaviour is quite overt and the length of time is longer for the children that we're talking about. There also appears to be a little bit more difficulty to interact and relate to others, and that while good quality childcare plays a strong role in supporting children and their families, the needs of the children have been actually quite challenging. Some of the children have also been continually unwell, and they're complaining of stomach pains, listlessness, and lack of appetite at various times.
Within the creche, there are only approximately three to four children attending one afternoon a week. And they - all the children there are exhibiting restlessness, even with two staff members and with parents on the site. It's quite an energetic session where the children really flit from one thing to another, not really taking very much in terms of direction; not really engaging in play for any length of time; and quite watchful. Again, avoid being touched, and want to repeatedly check that mum is still with them.
So they're the range of behaviours that we've been observing in the children specifically, and while with some children - because we've been providing supports for over a year now - there has been some reduction, at varying times we're actually seeing re-stresses, or if there's a change in the environments or slight differences to the numbers of children - you know, changes in the rooms - children reverting back to a range of behaviours. So there's quite a lot of passive play as well that occurs, where children are really kind of more observing play than actually engaging in play.
DR OZDOWSKI: Could I ask you how the frequency of these behaviours compares with the frequency of something like behaviours in broader population.
MS DELANEY-JOHN: Okay. Within the year we've supported 1025 immigrant children, so children are coming from cultural linguistically diverse backgrounds, not necessarily in care environments where they have staff who can interest and bond with the children very readily. Their behaviours are different in that we have children with separation anxiety, and that can be any child who has a separation from their parent because parents are going to English classes or vocational training, or it might be some counselling services. But the difference particularly that we've noted is that the separation anxiety appears to be heightened, and it appears to go for a lot longer in time.
We have had a couple of children actually vomiting from the separation that has occurred. And it also is to be noted that with five of the children particularly, one of the difficulties has been the crucial shortage of childcare, so I know that there is another impact. It's not necessarily in relation to an experience in a detention centre, but perhaps the ongoing trauma of settlement is the - with those five children, they're actually being picked up from their home from by a service of the childcare service and taken to the childcare centre.
DR OZDOWSKI: Is there a difference in level of services available to kids on TPV in comparison with other kids? No
MS DELANEY-JOHN: No.
DR OZDOWSKI: they are exactly the same.
MS DELANEY-JOHN: No. The services available are exactly the same. The availability of spaces, which is critical shortage, is exactly the same. There's a lot more work into trying to access those services and make them affordable for the families and the parents. Out of the children who were placed in care, there was - some children were absolutely relocated to services. One child was relocated three times; one was relocated five times; with unsettled behaviours. Some children are actually in two quite different environments during the week, so they might be in a pre-school for some of the time and they might be in a childcare service for some of the time, and both services are actually experiencing similar levels of behaviours.
So if, for example, the child is quite watchful and restless and not really interacting, we're actually finding that similar behaviours are occurring in either service regardless of which environment the child is in.
DR OZDOWSKI: Perhaps I will ask now Professor Thomas to ask you some questions.
PROF THOMAS: Ms Delaney-John, the children - do they get formal assessment so that they can be referred for formal intervention?
MS DELANEY-JOHN: Formal assessment is quite difficult. Some of the families are actually receiving torture and trauma counselling services.
PROF THOMAS: Yes.
MS DELANEY-JOHN: Of the children and families, we have six families definitely receiving torture and trauma counselling. The difficulty is any formal programs of - whether it be touch therapy or music therapy or any other therapy for that matter - dance therapy - it's not been forthcoming in a great way for the children. So the formal assessment has - is a difficult road to take. The formal assessment for any child, I must note - any refugee child - even though we have the special needs subsidy scheme of the Commonwealth, there have only been two children approved through that system.
PROF THOMAS: So is there any difference between the treatment and the help that the refugee children receive and the children who are from - are still on TPVs?
MS DELANEY-JOHN: There hasn't been a difference in help. What there has been is a difference in the time being spent to support the children, looking at inclusion needs. But in terms of assessment the systems are fairly weak for any child who has experienced war torn torture and trauma. And that's across the board in Queensland.
PROF THOMAS: And how about the mothers? Do they get support?
MS DELANEY-JOHN: Some of the mothers are attending the torture and trauma counselling service, as I'd said. Also other mothers who are going to, yes, I think mental health at Harmony Place for their English classes - like a conversational English class which is also a little bit of a social kind of gathering. Both Harmony Place and ourselves are looking at an application at the moment to go in to have a formal program for the children, which will be based on touch therapy and dance therapy.
PROF THOMAS: Of the children that you have observed, what is the longest time you have had to observe the children? I just want to see that long-term impact.
MS DELANEY-JOHN: Over a period of 13 months.
DR OZDOWSKI: So you see any improvement; any change at the end of 13 months?
MS DELANEY-JOHN: We've seen an increased bonding and a relaxation by some of the children, but then it can - there can be some regressions occurring and it also depends on how the families are feeling in relation to what they've articulated as long-term security or other issues that have been occurring for the family. So the children can be creating those bonds and then, for example, with some children there's been a change of staff member and those sorts of things so that's had another effect for the children. So we're sort of seeing three steps forward and two steps back and that sort of behaviour that's occurring with the children. As I said in the letter I sent you, I really can't state evidence that the children have been singly affected in relation to the detention centre. What I'm able to do is to bring to the table the behaviours that we've actually observed in the children in the length of time that's occurred, and with that and the other evidence that you receive to actually weight that.
DR OZDOWSKI: Are you saying you are not sure whether there's a linkage between the behaviour and the fact of being detained?
MS DELANEY-JOHN: We see the restlessness and the behaviours where children react when the gates get closed in the childcare centres. Most childcare services have the pool gates. We've also observed those behaviours in some of the refugee families as well, so we've done a lot of observation and worked with refugee families for five years, so while we are seeing some of the behaviours in the refugee children as well, there is much more challenge in working with the children who have come from the detention centres, and the ongoing distress for the families has - we believe also has an impact for the children. So I suppose I'm trying to be as frank as possible. With the children, one thing that did occur in relation to getting some materials together for this Inquiry was we sat down and we were looking at the statistics and the staff sat back and couldn't believe really that we were servicing 43 children because from their experiencing levels of stress in relation to the level of workload that had occurred for temporary protection of these children, and they had - it was only when we looked at it collectively that they realised they'd actually been supporting more refugee children, but the work level for the TPV children has been much higher. The work level also with the families and the observations in their homes where there doesn't appear to be huge changes in the behaviour of anxieties that are occurring.
DR OZDOWSKI: What percentage of TPV children would you handle out of 100 persons residing here in Queensland - what percentage of them would go through your hands?
MS DELANEY-JOHN: I wouldn't be able to state that. We have over 20 referral services that refer children to us and their families. I could only really comment on the 40 that
DR OZDOWSKI: That you met.
MS DELANEY-JOHN: Yes.
PROF THOMAS: You support culturally diverse children, so do you have also migrant children or children from - children who were born in Australia, but have migrant parents. Do you see the difference between these
MS DELANEY-JOHN: We don't see these range of behaviours. We see some separation anxiety. For some children who have come from business visas we do see children who will vomit due to separation anxiety, but they will have less ranges of behaviours. Some of the children have the sleeping - the withdrawal, the excessive hiding, the reaction to the gates, the watchfulness. They have a combination of those behaviours occurring for them, whereas with some of the children who may have separation anxiety they're exhibiting some withdrawn behaviours but an interest in observing children. So there is a difference in the way that they're actually observing what is happening. They don't appear to be jumpy and, you know, watchful and looking to see who's coming through the doors; those sorts of things. So the behaviours are quite different, and so the work undertaken for the inclusion of those children is definitely a lot less hours as well. Service providers are able to bond more readily with the children.
PROF THOMAS: Did you observe any difference in the mother/child interaction, you know, all these dyads?
MS DELANEY-JOHN: Well, obviously with the - we support - I think the most in the year that we've supported is 53 community language and within that there's diversity in parenting. However, if we're looking at the families we have some families where the children are quite clingy and bonded to families, but there does appear to be less touch, which may have some cultural practice in that, but it's - there is more disconnection in some respects. Families have indicated high levels of distress and their ability to perhaps engage in a very relaxed way with their children can have an effect. So we've seen children who are being collected by services from their homes and we've seen other children who were taken into the care situation by their families and parents have expressed the pressures that they're experiencing. And the sleeplessness that can occur because their children are sleepless.
PROF THOMAS: But over time, have you observed the mother/child interaction, because sometimes if the mother settles down and improves, that could have an impact on the children?
MS DELANEY-JOHN: Definitely. However, when we're looking at the children in the creche, those children are exhibiting restlessness, high levels of restlessness. It's - you know, staff are coming back. We've only got three to four children with two staff, and we've got parents on site, and the staff are coming back quite exhausted after those sessions and we're looking at ways to actually engage them more in play, yes. So the difficulty with stress is that you can have other factors on the long-term basis which affect families and the way that they're coping with those changes and the families have been expressing high levels of stress and so their ability to be relaxed with their children is affected.
PROF THOMAS: So do you have any recommendations for us?
MS DELANEY-JOHN: Yes, I do.
PROF THOMAS: More services?
MS DELANEY-JOHN: Really in Australia, and particularly in Queensland, we have only done some recent studies since 1997 in relation to children with post-traumatic stress and we really haven't got very good services that really respond to children and their psychological wellbeing even for refugee children. So if the government is to embark on continuing to detain children, given that there hasn't been enough work done, even though the body of evidence is showing that children are showing quite high signs of post-traumatic stress and they can have long-term mental health issues, I strongly do not believe that detention centres are the ideal environments for children and we're talking about children who are quite innocent of the politics that go on and the effects that occur and we're seeing through the expression also of parents the loss of childhoods and what effect that has for children. Detention centres are not an environment of supportive developmental childhood and I think it needs to be urgently addressed.
If there is going to be any reception areas, I do believe strongly that counsellors and therapists and early-childhood practitioners should come to the table to look at play in environmental centres which would be much more appropriate and supportive of family and children, and I would hope that, at the end of this Inquiry, that there can be some addressing of this.
DR OZDOWSKI: Thank you.
MS DELANEY-JOHN: I have tried not to be emotive, but it is very hard not to be emotive when we are talking about children.
DR OZDOWSKI: Just one more question.
MRS SULLIVAN: It's really a follow-up to your recommendations. You make quite a strong point in your submission about the greater length of time to support these children. Is your recommendation more of the same support or is it different support. I'm trying to think of a case management approach for these children. So is it just more of what we've already got or are you looking at more an alternative case management approach?
MS DELANEY-JOHN: I believe there needs to be specific early-childhood supported programs for the children. I would hope that the Inquiry is able to address what's actually happening for children now and in the future. So I suppose I see it as two things: one is about the detention of children which I think I've sort of stated fairly clearly my opinion on that, but also in relation to children who have come out of those services. I do believe that specific programs with smaller numbers of children with special supports of therapy and early-childhood, with family support so there is actually a family participation so that the resiliency is being built up in children and in their families and I think clear programs of resiliency need to be put into place. I don't believe that they're adequate or well-resourced at this point in time for the children. For that matter, I don't see that in place also for refugee children and I do believe that there are some steps that are needed within any settlement of children who have experienced war and war-torn torture and trauma, and environments of detention require those kinds of supports.
DR OZDOWSKI: Just a last question. The Department of Immigration has advised us that every child in a detention facility is case managed and that they are quite actively case managed. Did you see any evidence of it? Were any files transmitted to you?
MS DELANEY-JOHN: No.
DR OZDOWSKI: Nothing? Any indications
MS DELANEY-JOHN: Not one. Not one piece of document
DR OZDOWSKI: of information?
MS DELANEY-JOHN: Nothing - no information. I mean to say, we don't even know who's coming to Queensland. There is no transferral information, no information in relation to what programs were observed, what areas of concern for children's behaviour, any interventional or preventative or other supports that have taken place which we might be able to continue in any shape or form.
DR OZDOWSKI: Did you try to contact the department to access some records relating to particular children?
MS DELANEY-JOHN: There has been some contact and we've found it incredibly frustrating. So what we did is we basically worked with a clean slate when the children
DR OZDOWSKI: Why did you find contact frustrating?
MS DELANEY-JOHN: Who to contact, how it gets passed on, the perceptions of the Privacy Act of not passing on - it's quite - it was actually taking more time than what we actually had available to us which we needed to spend for the children. So there needs to be some transferral process in place. There needs to be some mechanisms in which that information can be shared. Even for children who actually were ill - we had some children which we had to rush to hospital who had been sick for some time and they had fevers and it had been going on for too long. Just being able to receive the information in relation to children
DR OZDOWSKI: To medical records of children?
MS DELANEY-JOHN: to the medical records of the children had been difficult as well. So it's been one of the hardest group of children, really, in terms of being able to respond appropriately to their needs and, in some respects, I feel that while we have attempted to do so, we have still managed to do that poorly.
DR OZDOWSKI: Ms Delaney-John, thank you for your evidence. One more question here from Professor Thomas.
PROF THOMAS: During the time that you have been helping these children, any of the families have sort of disappeared without notifying you?
MS DELANEY-JOHN: They've - I'm not quite sure what you are meaning there.
PROF THOMAS: One of the suggestions that have been made to us is that families while they are on the TPV may disappear, abscond, go into hiding.
MS DELANEY-JOHN: No.
PROF THOMAS: So have you ever had that experience?
MS DELANEY-JOHN: No. I mean to say, all the families that we have here, we have - even though they might have moved services, for example, one's moved five times within early-childhood - we still know their addresses, we still know where they live and if a parent has moved because there has been issued over accommodation and being able to settle, it's always come back to us in that - and even a couple of families who have moved, you know, have let us know so that, in my experience and in the experience of access, we have not seen that kind of behaviour at all.
PROF THOMAS: Thank you.
DR OZDOWSKI: Thank you very much for your evidence and for your submission.
MS DELANEY-JOHN: Thank you. Good luck with the Inquiry.
DR OZDOWSKI: And now I would like to ask Brisbane Refugee Health
Network and the Refugee Claimant Support Centre to approach the table.
Welcome. Could I ask you to take an oath or affirmation?
GABY HEUFT
MARGOT SALOM
ROHAN VORA [9.09am]
Brisbane Refugee Health Network
DR OZDOWSKI: Thank you. Now, could I ask you to give your names,
addresses, qualifications and the capacity you are in here?
MS HEUFT: My name is Gaby Heuft. I live at [address removed]. I am a member of the Health Network and also the co-ordinator at the Refugee Claimant Support Centre in Lutwyche.
DR OZDOWSKI: Thank you.
MS SALOM: My name is Margot Salom. I live at [address removed]. I am a medical and psychiatric social worker of 30 years experience and I am the health co-ordinator co-ordinating the Nursing Outreach Team at Brisbane Refugee Health Network.
DR VORA: I am Rohan Vora. I am a qualified doctor, a Fellow of the Royal Australian College of GPs. I live at [address removed] and I guess I am the medical co-ordinator for the Brisbane Refugee and Asylum Health Network.
DR OZDOWSKI: Thank you very much. Could I ask you, perhaps, to start with an opening statement and what I would like to ask you is to especially say a bit more about the Refugee Health Network, how you came into being, who finances you and also to indicate the level of contact you have with TPV children.
DR VORA: We came into being, I guess, about two years ago. We have actually had a minor name change since the submission where we are now called the Brisbane Refugee and Asylum Seeker Health Network. There are two reasons for this: one was to reflect more, I guess, the wide range of our work and cover all the groups we deal with and the other was to link with a sister group down in Melbourne called the Refugee and Asylum Seeker Health Network. We are also affiliated with the Darwin Refugee Health Network. We have a membership of about 70-strong in Brisbane itself plus many others outside in regional Queensland.
DR OZDOWSKI: 70 individuals?
DR VORA: 70 individuals. Most of us are professional health workers and allied health workers as well as community and development workers working in the area with a special interest in asylum seeker and refugee health. I guess our main focus has always been that we see ourselves as focusing on the health and human rights issues of this severely marginalised - or what we believe to be a severely marginalised group of people in Australia. We are informed in our vision, I guess, by the same sorts of documents that the Physicians for Human Rights Group that we have close contact with in the USA have been informed with. If I could just read briefly out of their vision statement where they say:
The right to health extends to all things which promote health and well-being and prevent illness. Health professionals hold a well-acknowledged commitment to the care of their patients. Discriminatory practices threaten physical and mental health and deny people access to reasonable care, or relegate them to inferior care. The devaluation of human beings and each other has had devastating consequences historically.
And I guess this is really a large part of our sentiment. Our work has been on a lot - besides service provision in terms of trying to set up links and networks with the AMA, with the Royal College of GPs, the Royal College of Psychiatrists, all the other medical and profession bodies in Australia. And as well as now joining with the Australian Nurses Federation, and I'm making a lot of contacts with the dental associations, both locally and nationally. And I guess most of our work in that area has been on the basis that if we, as professionals, start discriminating against people on the basis of visa category in terms of either offering them inferior care or not offering them care at all, we really slide down a very slippery slope for which there's a lot of historical evidence; that we no longer are really practising ethical health care. We're practising politics.
And once we go down this slope as a profession, the evidence is certainly there around the world, of where that is going to lead. And I guess that has been the basis of our work with the AMA, and most of the ethical associations in the college of GPs, the College of Physicians and the College of Psychiatrists has been that we really need to get our ethical committees onto the issue of detaining people and what sort of health consequences that has, particularly on the children. Our work in Brisbane has I guess for quite a while been very much focussed on the community based asylum seekers, particularly the 40 or so per cent of those who end up with no work rights, no welfare rights, no Medicare rights. Their children can't go to school.
And the reason for a lot of our efforts in that area is that they inform us, I guess, with what actually happens when you get no access to services whatsoever. And the evidence has gradually been mounting that children in this area are very severely affected. The evidence as presented before by the previous presenter, Jane, is certainly backed up with the work that we've done and we're seeing. The other issue is that we really work in a policy vacuum. In New Zealand, for instance - and I'll just show people the Refugee Health Policy Document. This was launched November last year. It was launched by the Ministry of Health. It's a refugee and asylum seeker health policy. We just do not have that sort of policy in Australia. So it's very hard for us as professionals to work in the area, which is basically totally policy free.
DR OZDOWSKI: Can I stop you for a moment and ask you about how are you financing? Are you financing yourself or you are supported by the Commonwealth or State Government?
DR VORA: We as an organisation are totally self-financed. I guess the reasons for that are that we had not sought funding because we want to maintain our independence.
DR OZDOWSKI: And about the contacts but with TPV children: how - what's your level of contact with TPV children?
DR VORA: We have quite a lot of contact with TPV children and I personally have gone over and done sessions at the Romero Centre which there will be presentations later on from the group there. The involvement there, I guess, of the Network has been in trying to set up services for these children; try and get services to be more refugee friendly. What we found was that people would arrive in Brisbane, and it would take them six weeks to get their Medicare cards. Now, things would go backwards and forwards between Department of Immigration and Medicare and so on, saying, oh well, they will get their cards. GPs can just sit and wait and they'll eventually get financed. But most GPs do not find this particularly acceptable, so that was certainly a barrier where they would then end up going to the emergency departments.
DR OZDOWSKI: You were saying about, in your submission, about third world care for refugees, and your submission was also mentioning that Medicare doesn't cover some services. Could you maybe let us know a bit more what are the areas of service for TPV children which are not covered by Medicare?
DR VORA: Well, Medicare doesn't cover their dental services. It doesn't
DR OZDOWSKI: That's like for most of other Australians, isn't it?
DR VORA: Yes.
DR OZDOWSKI: Where are differences?
DR VORA: Except that most of the dental services - the public dental services will actually cover a lot of Australian children; they were denying access to TPV children.
DR OZDOWSKI: Denying, yes.
DR VORA: To these services, particularly when they didn't have their Medicare card, and what we really found was that for the first six weeks there would be a lot of health problems that would occur during that time because they had saved them up in detention. I mean, we've had people who have arrived and who have had recent operations and really - our trying to get medical records is extremely hard. It's just not like phoning up another health practitioner and doing that.
DR OZDOWSKI: The Department of Immigration is telling us that every person on the release is given some kind of a medical health record sheet and that full documentation is easily available for GPs when they contact the Department of Immigration, but I see it's not your experience.
DR VORA: It's not a question of contacting the Department of Immigration; usually you have to contact a detention centre. From talking to nurses there it would seem that they are told probably late the day before the person is to be released that they are to be released and they have to get all the medical records organised. The evidence that we have is that, yes, they might arrive with a small sheet that says whether they're HIV positive or Hepatitis B positive or need a TB check or whatever, but you get very little else. Now as a GP I find that quite amazing because over 80 per cent of GPs in the country now are computerised to generate a - if you take proper medical records to generate a computer medical record is really a question of a push of the button, and it costs $200 per practitioner for that sort of a program so I don't really see that as being particularly complicated, so it seems strange that it's so hard for us to get medical records for a lot of these people. We've had people arrive with broken arms who were not treated in detention. Now whether that was because it was intentionally not treated or whether it was, as he feared, that he didn't want to tell them about his health problems including his arm pain because he feared that he would then be put in the other category and not be given a temporary protection visa.
DR OZDOWSKI: So you met people who were afraid of indicating their health standards because of the possibility of being kept longer in detention and denied a visa?
DR VORA: That's right, yes. That seems to be a very common fear and whether that's a rational fear or not, I don't know.
DR OZDOWSKI: What kind of condition are people in health wise when they are released from detention centres?
DR VORA: There certainly seems to be a lot of concern. We've had people who have been released with various illnesses that have not been treated. I guess when they get to a severity then they generally will get treated. Mental illness is something that is extremely poorly treated in detention centres, unrecognised, and often is considered from our experience to be something that they're blamed for.
DR OZDOWSKI: Mental illness or also any kind of stress?
DR VORA: Well, mental illness in terms of, I guess, the classics of post-traumatic stress disorder go unrecognised. People come out hyper-vigilant, constantly aroused, sleeping extremely poorly, often severely depressed. It has just gone unrecognised or untreated.
DR OZDOWSKI: Does this condition extend to children?
DR VORA: Yes, the condition certainly does extend to children. I mean, just on a personal level there has been quite a lot of concern really with children feeling totally disempowered and seeing their parents as being disempowered; sleeplessness, bed-wetting even amongst teenagers, even situations where you get young children ruminating about their own mortality and death and asking for their bodies to be returned to their country of origin if they do die; this from an eight year old is quite an alarming
DR OZDOWSKI: In detention, there are quite a number of self-harm incidents among children. Did you observe any self-harm incidents after children were released from detention?
DR VORA: It certainly is prevalent from our experience, and that's where I think it is extremely hard, because we, once again, are working in a policy vacuum where we just don't have the research funding to be able to go and research this group, you know, this marginalised group of people, but certainly as far as the suicidal behaviours; the intensity settles, the depression still remains, because a temporary protection is really a very insecure protection, and particularly we are finding now amongst a lot of the Afghans, particularly the unaccompanied minors, that they just don't feel safe, and a lot of those behaviours are starting to resurrect now.
DR OZDOWSKI: If they were given normal visas as permanent visas, not temporary protection visas, would it assist with their condition? Is their condition treatable, or will they cart it as luggage for the rest of their lives?
DR VORA: Well, I guess we have got to then look at the evidence of other refugee groups that come here with similar evidence of house torture and trauma, and yes, they will exhibit those things in the early phases, but they do seem to settle, and they do seem to gradually get over those. They seem to go on and have some hope - have some sense of purpose about life, and over the years really a lot of those behaviours diminish quite dramatically, but we don't see that in this group. In fact, at the moment, things seem to be getting worse for that group.
DR OZDOWSKI: Thank you, Dr Vora.
PROF THOMAS: In that sense, do you think that the people who are in the community, the TPVs, because they have no access to so many things, like you have just said, in a way that are they worse off than in detention, because in detention they get dental care, they get medical care to a point, you know, as another issue, but they do get those things; meals.
DR VORA: I don't think any of them would want to go back into detention.
PROF THOMAS: Yes.
DR VORA: I think that they see that as tremendously dehumanising, and degrading. I guess there is one other category that we are not looking at here; people have been in detention, and that's the recent group who are being released on the Safe Haven Visa, 449, and we have had several cases of this. Now, we are not arguing that they shouldn't be released. We think that is an excellent move on the part of the government to release them; however they are being released into the same situation as the community based asylum seekers, where they have no access to work rights, welfare rights, Medicare rights, the kids can't go to school. If you talk to - certainly our evidence is if you talk to them, they don't want to go back, but to be released to then have to beg for absolutely everything is extremely hard and, for children involved in this situation, it's just continues their parents' disempowerment. Often it will change the power relationships within the family. We find, I guess, in the medical area that then if the children do go to school and they get better at their language, than the parents - quite inappropriate use of them as interpreters to the extent where, as we have documented in one case there, was a young child who had to give evidence on the past torture and trauma history of her father which was extremely damaging to the child.
PROF THOMAS: So what would you recommend, that those people who are released should get full rights on - you know?
DR VORA: Yes. I would think that, really, the people who are released should get work rights, welfare rights, certainly access to Medicare and the children should get access to schooling. The vast majority of them want to work. They don't come from countries where they are used to welfare and work, I think, is extremely settling for a lot of people where we've had community-based asylum seekers who've had work rights and then had them withdrawn from them. They deteriorate very rapidly. The going-to-work seemed to be something where they could just put aside all of their other fears and anxieties and not settle, but feel that they had something that they could work towards, that they could then pay for their care, they could pay for various things. They didn't have to beg. So I think that people should be released. Where their refugee status has not been determined, should be released on bridging visas but with full rights.
PROF THOMAS: From the evidence we have been gathering, the mental health issues seem to be enormous. What recommendation do you have for this area?
DR VORA: I think that - yes, the mental health issues are enormous and I think that there should be a policy developed which allows the normal community paediatric services to take on a lot of the issues that we are seeing with children and that the community psychiatric services should be directly involved, should be trained particularly - or have their registrars - and there's a lot of interest in that - trained up in refugee and asylum seeker health. There is a lot of interest within the College in doing that; however, they need a policy developed within which we can all work.
PROF THOMAS: What do you think about the long-term impact of the experience in detention and then the early settlement in terms of mental health? Are you optimistic if they get proper treatment?
DR VORA: Our experience, I guess, is, with these people, they have been through a tremendous amount of trauma in their lives. When we've had them come along to - and amongst them you will get lots of professionals. They are doctors, they are nurses, there are health professionals. When they come along and we talk to them they say, "Hey, look, don't categorise us as having post traumatic stress disorder or depression. We can get over all of this. We'll show you how to get over them. Just give us work rights. Just allow us to settle. You will be surprised what we can get over." And I think that is quite true. I think that they would get over a huge amount of their trauma. Coming into the country and re-traumatising them makes it extremely hard, but, once again, they would probably get over that if we gave them a much more humanitarian way of being able to settle into the country.
PROF THOMAS: How about the children?
DR VORA: And I think the children, once again, if their parents settled, would be able to get over a lot of that trauma, and I think the evidence is there from past refugee families that have been very traumatised and their children have really grown up to take up some of the very high positions in Australia.
MRS SULLIVAN: I want to follow through your New Zealand booklet that you waved around before and ask you, for the record, some scenarios and what the answer to these scenarios is. If a refugee family turned up at a public hospital with a sick child, would they be treated?
DR VORA: If they were a community-based asylum seeker, they may well get turned away. Now, that's not necessarily by the doctor or the triage nurse, it may well be by a secretary who says, "Look, you haven't got a Medicare card; you have to leave." That will be the same, I guess, for the safe-haven visa, and that's what we have been trying to negotiate, and I think fairly successfully, in Brisbane with the major hospitals now. There seems to be a lot more understanding of those issues.
MRS SULLIVAN: So there is currently not a policy directive that says these people are to be treated in the same way as other people?
DR VORA: That's right. There isn't.
MRS SULLIVAN: Okay. If the same family turned up at a GP, would they be treated?
DR VORA: Once again, no. Without a Medicare card, they may well not get treated. With the Medicare cards, they may get treatment. The GPs without the infrastructure support that we have been really pushing for may well decide the case is too complex and they don't want to take it on.
MRS SULLIVAN: That is a prerogative of individual GPs?
DR VORA: That is a prerogative of the individual GP.
MRS SULLIVAN: And would that be changed by a new policy directive?
DR VORA: Yes, because, with a policy directive, just like you've got in New Zealand, you get training that goes on in those areas. There is also then a move to have infrastructure support which we have been pushing for. There are certainly item numbers that have been introduced in Australia to help GPs deal with mental health problems, with diabetics, with asthmatics, with complex health needs, but, with the asylum seeker and refugee population, you've got a complex addition to that in terms of having adequate interpreters and well-trained interpreter services, having community health services willing to provide backup and provide the infrastructure support before you can really access those item numbers.
MRS SULLIVAN: So one of your recommendations to us is additional item number?
DR VORA: No. Probably the infrastructure support that would support the item numbers that we already have in there, and having Medicare card access, and I guess developing a policy where the College of GPs and the various Royal Colleges and certainly the College of Psychiatrists has been very interested in having training for GPs in torture and trauma services in dealing with refugees, and that is going on on the ground level. I mean that's going on in Brisbane; it's going on in Melbourne; it's going on in Sydney.
MRS SULLIVAN: So the college itself has taken some initiative?
DR VORA: The College itself has taken initiative. I've been one of the focus people placed on the College. Now, we're developing our own register of doctors and now we're gradually moving to developing a register of specialists who are interested in the area in providing back up services.
MRS SULLIVAN: The third scenario is access to mental health facilities because we did touch on that earlier. If a family turns up at a health facility to seek mental health support, will that be given?
DR VORA: With the case study that we had in the submission of the community based asylum seeker, that was the third hospital that we tried to get him into. He was obviously extremely psychotic. His neighbours had encouraged us to try and get help and finally the third hospital we managed to get him in. He was at that stage seeing blood on the walls; he was severely depressed, suicidal.
MRS SULLIVAN: What I am trying to tease out here is whether there's special treatment for them given there's a back log of mental health needs anyway? Are they treated any differently?
DR VORA: No, they're not treated differently except that they may not get access. I guess the issues are once again that we need training within the mental health services of some of the special issues of torture and trauma in the asylum seeker and refugee population. And the mental health services have - certainly in Brisbane from my experience - been extremely on side with trying to develop training in these areas, but once again need back up from some sort of policy initiatives.
MRS SULLIVAN: There are some health services provided for children in government schools. There are school nurses for example and there's a certain amount of screening. There are school dental services. Have there been any children to your knowledge denied access to these services?
DR VORA: Well, certainly with the community based asylum seekers, once again, yes, they are denied access to those services. We are working with the dentists and we've got a project at the moment in development with the community paediatricians in Brisbane to work services up that will include them.
MRS SULLIVAN: So if they're enrolled in a state school, they don't go along to the school dental nurse?
DR VORA: As far as I know. I'm
MS HEUFT: I'm not aware of a case that has been turned back, but I'm also not aware of many children attending either so I don't have any statistics.
MRS SULLIVAN: That's fine. I'm just trying to get a feel for the quantum of services.
MS HEUFT: Yes. The issue for community based asylum seekers is that there is no formal right to attend a state school. Most of the children that I'm aware of are enrolled in small private schools because the parents feel the barriers of enrolling the children in a normal state school are just too large, and because of that I suppose the issue of no access to dental vans etcetera has arisen for us.
DR OZDOWSKI: And what each child needs to do after being released from detention centre and arriving in Queensland to get access to a school.
MS HEUFT: Yes. I'm speaking on behalf of community based asylum seekers that have not been in detention but that are living in the community on bridging visas. And their access to schools, Medicare cards and services is different in some respect to TPV children.
DR VORA: And it would be similar to the safe haven visa 449, release from detention.
DR OZDOWSKI: Just last question. You mentioned in your submission wrist and dental x-rays which are being used to determine age and so on, and you challenged the validity of that material. Would it be possible to ask you to provide us with some references to that material? We are looking at the issue and if there is any material and literature about unreliability of this material, could you provide us with references. If not now maybe to take that question on notice and provide us at a later stage.
DR VORA: Yes, I can provide it at a later stage and I've had discussions with the Australian Dental Association particularly some of those that do radiology. The Australian Radiologists Association and the Health Alliance obviously has been interested in this area. I guess most of my scientific type data comes from a Physicians for Human Rights Group in the US that has done a lot of work in this area - and that was the information that I put in the submission - was directly from them. We're trying to get and we just don't have and whether the Commission can help find this evidence is just where it has been used in any way in Australia.
We have evidence from our Canadian contacts that there have certainly been Australian representatives at meetings in the US looking at the use of dental x-rays for age in children. We have some anecdotal evidence of its use in Australia to basically, I guess, to categorise people as being over 18 where they weren't sure of their age so they could then be treated in a different way and not as unaccompanied minors. Now, from my talking with the radiologists' college, there is absolutely no evidence whatsoever and it's totally unscientific to use this on that basis. It's used really only for staging operations to see whether there is any growth potential and that you might do different operations for. But it has no validity whatsoever to use it to decide whether someone is 18 or not.
DR OZDOWSKI: I'm not aware of the use of dental evidence but I'm aware of the use of X-ray wrist - X-ray evidence and that's what we're interested in particularly. Okay, so is there anything else you would like to ask or is that all?
DR VORA: Yes, I'd just like to add that part of the reason for our submission - we're part of the Health Alliance submission, but we were urged to place a separate submission. And part of the reason for that was that we were very strongly looking at community based asylum seekers because our fear at that stage was that more people would be released on some sort of bridging visa and denied access to this. Now, the release - SHV449s has certainly confirmed our fears. And I guess our submission there is that what happens is you release people from detention but you release them to a much more insidious form of detention which is that you release them into a situation where they have to beg for absolutely all their human rights in everything.
DR OZDOWSKI: Thank you very much. Thank you to Brisbane Refugee Health Network.
Now, could I ask Mr Mark Huxstep to come forward? Welcome, Mr Huxstep. I'll ask you to take an oath or an affirmation.
MARK HUXSTEP [9.42am]
Former nurse from Woomera
DR OZDOWSKI: Now, could I ask you for the record to give your name,
address, qualification and capacity in which you are appearing, please?
MR HUXSTEP: My name is Mark Huxstep. I'm a Registered Nurse. My address is [address removed]. I'm appearing in the capacity of a former nurse at the Woomera Detention Centre.
DR OZDOWSKI: Thank you. You possibly sat in the audience for some time and you heard my orders relating to the privacy.
MR HUXSTEP: Yes.
DR OZDOWSKI: Basically it's a basic order that we shouldn't be using names here in order to protect privacy of refugees. And if you'd like to provide the names later our Secretary will take them and on some occasions it's good to do so, so we can follow up the case and cross-check the evidence.
MR HUXSTEP: I understand.
DR OZDOWSKI: Could I ask you to start with an opening statement and in particular if you would like to address the length of the association you had with Woomera Detention Centre.
MR HUXSTEP: Certainly. I'm a registered nurse. My background is in critical care nursing - my specialty - that's intensive care, emergency department and operating theatre. I worked at the Woomera Detention Centre from August 2000 - early August 2000 - until mid-February 2001 as a registered nurse.
DR OZDOWSKI: So one could say that you worked in the relatively early stages. Did you maintain any contact with people who were there after you left?
MR HUXSTEP: I have seen some people that were detainees at the time that I was working there since their release, yes.
DR OZDOWSKI: I see. What about the medical people - nursing people - working in Woomera; did you maintain some contact with them?
MR HUXSTEP: Yes, I have.
DR OZDOWSKI: So you would know if there were changes since you worked in the late 2000-2001?
MR HUXSTEP: People that I've maintained contact with haven't returned to work at Woomera since they finished working there, so I'm not aware of specifically any changes.
DR OZDOWSKI: Could I ask you also why you left Woomera? You had, as I understand, three 6 weeks contract over there and then I think you decided not to seek renewal?
MR HUXSTEP: That's correct. I was offered ongoing contracts with ACM Australasian Correctional Management at the Woomera Detention Centre but I declined to accept them because I found that the work was having a mental effect on me, it was distressing me and I was unable to sustain that type of work.
DR OZDOWSKI: What do you mean that type of work? What do you mean that it was having an impact on you?
MR HUXSTEP: I found witnessing people in that environment to be emotionally, and mentally, distressing to me. I found that I was unable to change the situation for them and the conflict that arose from that for me was I was unable to sustain it any longer.
DR OZDOWSKI: I understand you were also, for a short time, acting manager in the health centre over there?
MR HUXSTEP: That's correct. The last 5 weeks of my last 6 week contract I was acting manager of the medical centre at the Woomera Detention Centre.
DR OZDOWSKI: And who were you responsible to when you worked as an acting manager?
MR HUXSTEP: I was employed by ACM and I was responsible to the centre manager at Woomera.
DR OZDOWSKI: Could you, perhaps, describe the condition at Woomera and especially how it related to the medical centre?
MR HUXSTEP: The conditions - the environment - is particularly harsh. It's a moon scape. It's dust and rubble. There's no grass inside the compound. There's sparse brush on the red desert outside the compound. There's one tree in the main compound, double palisade fencing around the entire perimeter with razor wire top and bottom. There are different compounds divided up by fences. Quite often there are barriers between the compounds so that detainees can't see, or hear, one another speaking or see each other. It's particularly hot in summer. The main compound: there was a temperature of 61 degree Celsius recorded the summer that I was there and it's bitterly cold at night in winter.
Detainees have to line up at gates with their identification passes with their name and number on it and ask permission to go to the medical centre to seek help for problems - health problems. They have to line up to see DIMA about any problems.
DR OZDOWSKI: How long did they need to wait to get medical progress?
MR HUXSTEP: It depends on the time of day. If people are lining up to go for meals it can take longer. If it is in the night-time after 7 pm there's only one nurse manning the medical centre between 7 pm and 7 am to see the entire population of detainees and the practice, at the time I was there, for the nurse to take medical charts and drugs to different compounds and have a half hour clinic in each one. In those times if somebody from one of the other compounds needed to see a nurse they would have to line up at the gate for their compound to get to the medical centre. Sometimes they waited for hours.
DR OZDOWSKI: For hours to get - to see a nurse or
MR HUXSTEP: To see a nurse. There's no doctor at night.
DR OZDOWSKI: And in terms of seeing a doctor, who was controlling access to the doctors?
MR HUXSTEP: Many people were controlling access. There were guards at the gates. They sometimes made a subjective judgment that people didn't need to see a doctor or a nurse and were turned away, particularly if the guard had a personal relationship with the detainee in which that they dislike them then the acuity of their health problem, if they needed to see a doctor for something that's perceived to be less acute than - we had limited resources - the local GP came to our clinic each morning at Woomera and there was a DIMA doctor who was present through the day and was on call at the week-ends.
DR OZDOWSKI: So what you are saying is that on occasion guards played doctors?
MR HUXSTEP: Sometimes they would make a subjective judgment that the person didn't need to see a doctor or a nurse, yes.
DR OZDOWSKI: Tell me what was the relationship between the doctor and the nurses? We've had information that the person who was in charge of medical centre, and usually it was a nurse, was second-guessing decisions of the doctors. Are you aware of this kind of situation especially when it was coming to more expensive treatment and so on?
MR HUXSTEP: I personally didn't witness that happening, no.
DR OZDOWSKI: So what was the relationship between the doctor and yourself when you were the manager?
MR HUXSTEP: When I was the manager the doctors were more than - I mean, as trained health professionals the patients' health outcomes are our primary focus. I wasn't aware of anyone not getting the treatment that they needed because of the cost. Certainly if there were less expensive treatments available for the same outcome that would be better, but people didn't get - did not get the treatment they needed based solely on cost.
DR OZDOWSKI: On cost. Who is paying in Woomera for the cost of medical treatment which had to be provided outside of which it was a bit out of extraordinary, more expensive?
MR HUXSTEP: I asked that question myself and I was told that ACM would pay the bill and they would be reimbursed by DIMA.
DR OZDOWSKI: I see. So basically the final paying authority was DIMA. So did DIMA have any rules which were limiting the expenditure on medical - did they have a policy?
MR HUXSTEP: They had policies, for example, many people would come to the medical centre with eyesight problems and complain of headaches or poor vision and it fell to me, several times while I was there, to refer them to the GP who would refer them on to a place in Port Augusta for eyesight assessment. And often they would come back with a - the report would come back from the specialist in Port Augusta to say that these people did, indeed, need glasses, for example, prescription glasses. I would send a recommendation-type letter and send it off to the centre manager and it became a practice to send a copy also to the DIMA manager asking that the person be allowed to have glasses and that they pay the bill.
On no occasion during the 18 weeks that I worked there did anyone get glasses that were prescribed them and I was actually admonished by the centre manager through the health centre manager while I wasn't working as the manager there for pursuing the matter and told that people didn't need glasses, they could follow that up after they got released and that our brief was to look after their basic health care needs and not go beyond that.
DR OZDOWSKI: And glasses were not
MR HUXSTEP: Glasses were outside the parameters of what they were prepared to pay for.
MS LESNIE: Do you have any other examples of things that were outside that sort of basic needs category?
MR HUXSTEP: Dental, again. We had a dentist come several times while I was there. It was made on an ad hoc arrangement. There was no routine or specific dates and times that he would come or how many people he could see or how long he could stay and he told me one day that basically his only treatment that he could provide would be extractions. There was no drill or anything like that available. He had no other equipment other than instruments for extracting teeth.
DR OZDOWSKI: Did you have a dental chair at this time?
MR HUXSTEP: No, we did not.
DR OZDOWSKI: So how to extract
MR HUXSTEP: People would sit on a chair and he'd examine them and if extraction was - he felt that that was the most appropriate treatment, and under the circumstances that's all he could provide, he could give them an injection - a local anaesthetic - and remove the tooth.
DR OZDOWSKI: Just a normal chair?
MR HUXSTEP: Just a normal chair, or a stool sometimes. You
MRS SULLIVAN: Have you got any examples where children were denied access to some resources that you just mentioned?
MR HUXSTEP: Children were denied access in several ways, not just directly but also indirectly. For example, there was a child who presented to the medical centre and it just so happened that her mother was a qualified doctor in her country of origin, and the child had painful ear, so the child was given a simple pain killer that evening and referred to the doctor the next morning, who diagnosed an ear infection and put the child on regular pain killers and antibiotics. It was a liquid antibiotic that had to be refrigerated. The detainees aren't allowed to take medications back to their rooms for fear that they will overdose or collect them or whatever the rationale, and so therefore they had to come to the medical centre four times a day to get their medications. That meant coming every six hours with a small child with a sore ear who was crying in the middle of winter at night time, waiting for two hours in a queue at the gate in the freezing cold and it just happened to rain one night, and the mother was terribly distraught. She said, "I'm bringing a sick child to stand in a queue in the cold and the rain for two hours to get treatment," and I had no answer because it was true.
MRS SULLIVAN: You heard comment earlier about medical records. Would you like to comment on that from what you saw and what you saw given to people when they left?
MR HUXSTEP: I wasn't directly involved in that role. DIMA, as it was known at the time, seemed to have very strict control of what the nurses could find out about who would be - whose release was imminent for fear that we would tell them. So therefore that was kept in - behind closed doors. The records were requested sometimes less than 24 hours before a Tuesday or a Thursday morning, which was usually the release time for a whole range of people, not always did any of them get out the next morning or some of them did, some of them didn't, and that was - I took to be a way of us disseminating this information. We didn't know who was going. So consequently the records weren't always complete. I witnessed on many occasions information being put into patients' notes and when I would check some days or weeks later the information that I had put into patients' notes was gone and I would put the same information back into the notes and on one occasion in particular a statement I put into a patient's notes was removed on four separate occasions.
DR OZDOWSKI: Who was removing it?
MR HUXSTEP: I don't know.
MRS SULLIVAN: This was handwritten notes?
MR HUXSTEP: No, it was a typed statement I wrote about an incident pertaining to one particular detainee and I kept a record on the computer in the medical centre which was password protected and each time I would check his notes and the statement wasn't there I would print another copy, sign it, put it in the notes. He was - I think during my second tour at Woomera he was sent to the Perth Detention Centre and I checked his notes before he left and the statement was not there and I put a fifth copy into the notes.
DR OZDOWSKI: Can I ask you where the statements - where the files were kept, they were accessible to everyone?
MR HUXSTEP: They were at one end of the medical centre and there was a red line on the floor and detainees and guards were not supposed to cross the line, but I know for a fact that many times, particularly during night - during the evening when there was one nurse on and we were outside doing clinics in other compounds, that you could come back and find guards sitting there unaccompanied in the medical centre, so I can only presume that they had carte blanche access to the medical records. There was no lock on the filing cabinets.
DR OZDOWSKI: So they were checking - there was no possibility that a detainee was removing the
MR HUXSTEP: No, no, no, no, no.
DR OZDOWSKI: What kind of incident it was?
MR HUXSTEP: It was about him being injected with a sedative, being held down by guards and injected with sedative by another nurse against his will.
DR OZDOWSKI: Was it justified by his behaviour or under what conditions was the sedative given?
MR HUXSTEP: The information I had afterwards was that, no, it wasn't justified.
DR OZDOWSKI: Not justified in medical terms. It was just
MR HUXSTEP: No.
DR OZDOWSKI: used for
MR HUXSTEP: No.
DR OZDOWSKI: the purpose of control
MR HUXSTEP: It was - it was chemical restraint.
DR OZDOWSKI: A chemical restraint. And what was the policy about using chemical restraints? Did you have any kind of formal procedure?
MR HUXSTEP: I never saw a policy on it.
DR OZDOWSKI: So how was it happening? How were chemical restraints used?
MR HUXSTEP: That was on the only incident that I saw. I have anecdotal evidence from other nurses that were there previous to me that it happened on other occasions, but the only incident that I'm personally aware of is in this instance.
DR OZDOWSKI: Did it need to be authorised by a doctor? The issue of the use of chemicals?
MR HUXSTEP: The practice in any health facility is that if you need a doctor's opinion, particularly on giving medications, that you ring the on-call doctor and explain the problem to them and the situation and make any suggestions. They will then prescribe a medication and the route and dosage to be given and a second nurse will take the information - witness the information over the telephone, and then it's written in the medication records as a phone order, and it's given. Within 24 hours a doctor will then sign that order.
The nurse that gave the injection rang the on-call doctor at Roxby Downs who prescribed 100 milligrams of a drug called Largactyl to be given as an intramuscular injection, and I cautioned the nurse to - that I thought the dose was excessive, and I wasn't aware of it being given via that route commonly. She gave it anyway and the detainee was so sedated he had to be brought to the medical centre. The guards had used their plastic handcuffs called flexicuffs. They had cuffed his legs together and his arms behind his back and he was put face-down on a bed in the medical centre and I asked them to please remove the handcuffs and move him onto his side in case he vomited and aspirated.
There was much debate about that and they finally did it. They cuffed him with his hands in front of his body and sat him up. He then proceeded to vomit and I had to suction his airway and apply oxygen to him and I rang an ambulance and sent him to hospital, because I was afraid that he could - his health status could decline.
DR OZDOWSKI: But why he was given this sedative in the first place? Was he
MR HUXSTEP: Because apparently - the story I was told was that he had been made aware by the guards that his application for a temporary protection visa had been unsuccessful and I think it was his second appeal and that he would be going back home. So yelled and screamed a bit and he was put in solitary confinement in Sierra compound and apparently he became quite demonstrative emotionally and yelled a couple of times and banged his head on the wall in frustration. So then the guards held him down and radioed for the nurses to come. The nurse that I was on duty with at the time - I should say the first time I went to Woomera the night shift was two nurses. Subsequent to that it was one.
And I had been at the detention centre at that stage about a week. And she said I should stay in the centre and be available for the other detainees, that she would go and sort the problem out. The guards that manned the Sierra compound normally were from the group that were from the maximum security prison in Brisbane and this nurse apparently is also a career nurse with ACM from that facility. She went off and came back, rang the doctor. I listened to the order and then she went and gave the injection.
DR OZDOWSKI: And then the man was taken by ambulance to hospital, yes, your
MR HUXSTEP: To Woomera Hospital.
DR OZDOWSKI: And how long did he spend there?
MR HUXSTEP: The best part of the evening and then he was sent back when he was assessed that his level of consciousness had returned to an adequate level that he could protect his own airway.
DR OZDOWSKI: And where he was kept then after he was returned to Woomera?
MR HUXSTEP: Back into Sierra compound in
DR OZDOWSKI: Into the separate
MR HUXSTEP: Yes.
DR OZDOWSKI: isolation rooms?
MR HUXSTEP: Yes.
DR OZDOWSKI: And how long did he spend in that isolation?
MR HUXSTEP: As far as I know, he stayed in Sierra - I don't know about isolation, but he stayed in Sierra until he was taken some months later off to
DR OZDOWSKI: Perth.
MR HUXSTEP: Perth. In the interim I think he spent some time in prison in Port Augusta, I believe, because it was alleged that he was a participant in the riot.
DR OZDOWSKI: Now, can we in a way change the topic now and I would like to go to the issue of medical facilities. And in particular I would like to focus on children and food for children. Quite often we heard that the milk formula was not available for young babies or that it was available sporadically. Do you know anything about availability of milk formula for babies over there?
MR HUXSTEP: Whilst I was working at the Woomera Detention Centre there was formula available for the babies. There was - most of the time there was a midwife available who looked after the post-partum mothers, the pregnant women and the small - the neo-natal babies, small babies. The problem I found with formula specifically is that after hours if the midwife wasn't the nurse that was on duty on the night-shift that she would make up enough bottles for the small babies in the camp and distribute them to the different compounds and ask the guards to give them out to the mothers with their numbers and names and the times that they should be given out.
And the guards weren't always very vigilant in who they gave them to or how many or the times. Subsequently some children missed out on their formula and then the mothers would present to the medical centre the next morning very distraught if they had hungry babies.
DR OZDOWSKI: It was a regular occurrence or it just happened once by accident?
MR HUXSTEP: It was very common and it didn't seem - because the guards would not always be the same ones on every night shift. You could explain until you were hoarse and put up instructions, very clear instructions in each compound and it didn't seem to make any difference. They didn't take any notice and they gave out the wrong number to the wrong people. Some mothers would come and say, "My child is hungry" and they would just hand them a bottle. They didn't know who they were or if they had a small child or
DR OZDOWSKI: And how mothers were warming the milk to give to the children because usually you need to have a proper temperature and so on?
MR HUXSTEP: The guards would - the guards in the building that they had in each compound would put them in the - they had a microwave oven for their own use.
DR OZDOWSKI: Okay.
MR HUXSTEP: And they would warm them in the microwave oven.
DR OZDOWSKI: Okay. And when the formula was mixed was it done in hygienic conditions?
MR HUXSTEP: As best as possible. We had a container and Milton to soak the bottles and the teats in but we were using a sink, the only sink in the medical centre and it only had cold running water and it was used for many other purposes.
DR OZDOWSKI: What other purposes?
MR HUXSTEP: One of the jobs that the detainees - because as one of the previous speakers said they were desperate to work and the only job really available there was to work in the kitchen as a kitchen hand. So that was a very sought after job. One of the - part of the screening process to work in the kitchen was a health screening and to screen for any bacteria that they might have they had to come to the medical centre and ask for a container and have explained to them they had to provide a sample of their faeces to be sent to pathology and screened for different bugs.
When they brought that back half of that had to be decanted into a specific medium so that whatever - you know, certain types of bacteria didn't die. So that was all done at the same sink that we made up the milk bottles for the infants, decanting human faeces from one container into another and send - packaging them up and sending them up to pathology. It was the only place we had.
DR OZDOWSKI: And the other specific food needs of children, were you involved - my understanding is that sometimes doctors were prescribing special diets for children?
MR HUXSTEP: Sometimes they were prescribing additional nutrient groups for children and pregnant mothers and breastfeeding mothers, extra fruit, extra milk. Often the food - I mean, I used - if I had to go into the kitchen the smell made me nauseous. They were given quite often fried food, fish and chips or, you know
DR OZDOWSKI: Were there any special meals prepared for young people there?
MR HUXSTEP: No, the children had the same as the parents.
DR OZDOWSKI: And the same timing?
MR HUXSTEP: The same timing. And the kitchen services were privately owned and operated at the time I was there and these predominantly detainee labour which, I believe, they pay the equivalent of a dollar an hour which the people could go and buy phone cards for, and yet they were reluctant to provide extra - appropriate food, more nutritionally beneficial food, extra fruit or extra milk.
Indeed many - many pregnant breastfeeding mothers would come and ask for a second glass of milk and they would be in tears because the kitchen had said, "No, one glass is enough per day". The same with children. The children were only allowed to have one glass of milk a day.
DR OZDOWSKI: Perhaps I will allow my Assistant Commissioners to ask questions.
MRS SULLIVAN: I just wondered whether it's possible to list the three or four major health issues for children that you observed while you were there and perhaps compare that with the population where you're now working?
MR HUXSTEP: Yes. They didn't come to the medical centre a lot. I think they were afraid. Sometimes they would come with their parents. The older kids and the teenagers sometimes would come in with non-specific problems and I think a lot of the time it was just for a chat. We used to see bumps and scrapes, normal kid things, they would fall over. Specific incidences, there were cases of children, who in discussion with my more learned mental health colleagues, were exhibiting behaviours and symptoms of depression and post-traumatic stress disorder.
But for the main part it was ear infections and runny noses and sore throats and, you know, headaches and colds and flus and run of the mill things. As compared to the general population I don't have specific numbers. I don't work in an area now where I see a great - a great cross-section of the general public with those sorts of problems, however, I think that the environment and their mental state and the diet they were provided certainly didn't predispose them to good health.
MRS SULLIVAN: Did you see any inappropriate medication of children and young people?
MR HUXSTEP: There were a great deal of people who were on anti-depressants.
DR OZDOWSKI: Including children?
MR HUXSTEP: I was trying to think when I was listening before, the age of the youngest person I saw on an anti-depressant would probably be 10 or 11 years old. The children seemed to be - seemed to absorb the mental state of their parents and many of their parents were feeling helpless and hopeless and demoralised and disempowered and I think that's how the children felt too when you talked to them. It's just - it was just shocking.
MS LESNIE: Did you ever see an example of a child who had self-harmed?
MR HUXSTEP: Self-harm. Certainly teenagers, not - 15 or 16 perhaps would be the youngest person I saw.
MS LESNIE: And what was the procedure if a child had self-harmed? What happened with that child? What if they went to the medical centre?
MR HUXSTEP: Their immediate medical needs were met, that is if they were bleeding or - that's usually - you know, they would cut their wrist or something. The only time I saw that happen the cuts were superficial. They hadn't - they hadn't cut any blood vessels so there was a dressing applied and they were referred to see the doctor as soon as possible. And also when we had a psychologist on site they were to see the psychologist. Failing that one of the mental health nurses if there was one.
MS LESNIE: Was there any sort of observation procedure for those children? Were they ever put into an observation room?
MR HUXSTEP: The same as the adults would be. I think that that was perceived to be of more potential harm than good. The guards would certainly pay regular visits to their - to their donga to check on them hourly and the nurses would make home visits as regularly as they could, particularly the mental health nurses would follow them up, you know, and call in several times a day and through the evening. And the parents were made to be aware that they should be vigilant.
DR OZDOWSKI: The self-harm you were mentioning, did it involve suicide attempts?
MR HUXSTEP: Not while I was at Woomera. I didn't witness anyone who made a genuine suicide attempt, not a child.
PROF THOMAS: You said there's a psychology service in the detention centre. What do you think of this service? Is it adequate, effective?
MR HUXSTEP: When the psychologist was there he was very good and he had an intern with him who was very good, however, there wasn't always a psychologist available. Indeed when the first - when I was at the early part of the time I worked at Woomera there wasn't a psychologist and even the services of the mental health nurses was arranged in a very ad hoc fashion. And there was a period at one stage when I was there for two or three weeks where there was no one with mental health training available.
PROF THOMAS: When the services were available did you find any children using them?
MR HUXSTEP: I wasn't directly involved but again in conversations with my colleagues many of the people they spoke to were children. And one of the psychologists, who has also talked to the Commission, told me when I was there that he had at least six children that he was very worried about at the time who were in detention.
PROF THOMAS: Did you have any opportunity to observe the behaviour of the guards with the children?
MR HUXSTEP: Many occasions, and I should say that not all of the guards exhibited unprofessional behaviour but many of them did and there were many instances. I remember I had to go in to the main compound to do a medical clinic one morning and because we were nurses we had to take a guard with us for protection, I presume. And we were waiting our turn to go through the gate to get in to the compound and there was a family returning from the kitchen with their meals, and there was a child ran through without waiting and when the guard yelled at him he said something rude to him and kept going. And the guard said to me - he looked at me and said, "I wish I could have five minutes alone with that little c-u-n-t". And I said to him, "What would you do if you had five minutes" and he made a hand punching - his fist punching his hand motion and smiled, and the child would have been eight or nine or ten.
PROF THOMAS: You say that after your work at Woomera you had problems with this stress and had to have treatment. Did you get compensation or Workcare?
MR HUXSTEP: I have paid for it myself and I've made a claim for compensation against ACM, but that hasn't been lodged in the Court to my knowledge as yet.
PROF THOMAS: Okay. Before you went to Woomera were you sort of prepared? What did you expect about the place?
MR HUXSTEP: I had seen reports on TV but I wasn't prepared for the physical environment being as barren as it was. I wasn't prepared for the attitude of some of the staff I had to work with. I wasn't prepared for being a trained health professional having my judgment set aside because of security issues; having my judgments questioned by people with no health training. I wasn't prepared for the level of depression and hopelessness of the population of the detainees, the desperation. The stories they told me were in many cases just beyond belief of what they'd already suffered before they came to Australia, and then to be put in to prison in the middle of the desert away from society for an indeterminate period of time and told nothing. People would come to me and say, why don't DIMA at least tell us what is happening with our visa application? They don't come near us unless there is a riot or there is a crisis and we don't hear from them. So I wasn't prepared for that.
PROF THOMAS: Were you given any training on cultural diversity?
MR HUXSTEP: No. The only training I received from ACM, we were asked to watch a training film made for American prison guards in the seventies which advised people should they be taken hostage that they should not act like a corrections officer but a normal person, and I thought that was fairly appropriate because many of them didn't act like people most of the time.
PROF THOMAS: But the place needs professionals like you in - health professionals
MR HUXSTEP: Yes, they do.
PROF THOMAS: doctors and so on. So what advice would you give to the people who are about to take a job there?
MR HUXSTEP: Don't go. They do need them but the cost of running Woomera, I think, is undeniably huge. By DIMIA's own statistics up to 92 per cent of people are successful with their visa applications so why are 100 per cent of asylum seekers punished by being put in the gaol in the desert and for an indeterminate period of time? I think it's fairly obvious, you know. People who are accused of crimes, and people who have been convicted quite often of crimes, are given much better conditions than the people who come here seeking asylum after being traumatised in their own countries.
PROF THOMAS: Thank you.
DR OZDOWSKI: Did you witness any riots?
MR HUXSTEP: Yes.
DR OZDOWSKI: What is happening to children during such riots?
MR HUXSTEP: The children weren't visible for the most part. I think the parents - the smaller children, particularly, were locked up in their dongas.
DR OZDOWSKI: Who locked them up?
MR HUXSTEP: The parents - well, I presume the parents. We weren't allowed in to the compounds or within, you know, close proximity to the compounds. There were their lights on the compound. There were many, many, many, many, many guards in full riot battle dress around the perimeter and we were told that the use of the water cannon had been authorised, and they explained the types of injuries that the water cannon can inflict, where it will hit the skin and shear the skin off in great flaps. We were told that we were not to treat any detainees that were hurt, only guards, and the
DR OZDOWSKI: So what you are saying, guards had priority?
MR HUXSTEP: We were told we were not to treat any detainees, only to treat guards. A medical centre was set up outside the perimeter just up the road from the detention centre, and guards who had been hurt in the melee would be ferried up to us for treatment and either rest there or go back on duty.
MRS SULLIVAN: Who told you to treat only guards?
MR HUXSTEP: The medical centre manager said that she went to a management meeting with all the other department managers each morning, and also had the centre manager and the DIMA manager present, and she came back from the meeting and said that there was intelligence to the effect that there was going to be a riot soon. If that happened, this would be the sequence of events and we weren't to treat detainees, only guards.
MS LESNIE: Do I understand that you - you set up a medical centre down the road so, in fact, there were no medical staff on site if there had been some injuries?
MR HUXSTEP: No, no.
MS LESNIE: There were no medical staff?
MR HUXSTEP: No.
MS LESNIE: So if a child, for instance, had got caught by a water cannon what would have happened to that child?
MR HUXSTEP: A guard would have to notice it and bring them to us.
MS LESNIE: So a guard could bring kids or anyone else to your medical centre down the road?
MR HUXSTEP: Theoretically but it didn't happen. No detainee was brought to us.
MS LESNIE: And were there any detainees injured in that riot?
MR HUXSTEP: I suspect so; however, I think for fear of punishment for a week or two after the riot no detainee presented to the medical centre with any injury which they claimed came directly from the riots. Sometimes they would come in with a cut or a bruise or a sprain which obviously wasn't new and they would say that they just hurt themselves playing soccer or something.
DR OZDOWSKI: But you didn't observe the riot yourself personally so you don't know what kind of
MR HUXSTEP: I observed the main compound at different times through the evening from a distance; the closest I got was about 150 metres. I observed detainees throwing small rocks from the compound across the fences at the guards. I observed guards and members of the Country Fire Service from South Australia, who were also present with their fire truck and hoses, throwing rocks back. The detainees were running round and round the compound with towels and things around their head to preclude identification.
DR OZDOWSKI: But you didn't see children or young men under 18
MR HUXSTEP: I personally didn't see anyone that I would presume from their size to be younger than a teenager.
MS LESNIE: Could you comment on the impact that that had on children? Whether or not they were there did you notice
MR HUXSTEP: The immediate effect straight after the riot was that the children who did come to the medical centre my perception was they were a lot quieter, a lot more guarded in their - a lot less likely to make eye contact.
MS LESNIE: Was there any effort to bring in child psychologists or other psychologists just to assess the children after that?
MR HUXSTEP: I believe a colleague of mine, who was a psychologist there at the time, made that suggestion and he told me that the response at the time was that they didn't feel it was necessary or that the cost was warranted.
MS LESNIE: Was he a medical practitioner? When he said that he didn't feel it was necessary
MR HUXSTEP: Psychologist.
MS LESNIE: He was a psychologist?
MR HUXSTEP: Yes.
DR OZDOWSKI: There is a final question I would like to ask you. Usually when there are incidents involving children in terms of South Australia, one should file a report with the Department of Family Services in South Australia reporting especially if a child was hurt. Could you tell me what was the procedure of reporting such incidents and how effective were the investigations?
MR HUXSTEP: The first time I arrived at Woomera was hot on the heels of a report a nurse had made about a child who was allegedly sexually assaulted and, apparently, the procedure up to that point had been that if a child had been harmed or suspected of being harmed, that the Centre Manager was to be notified and if any authorities - he deemed it necessary to notify any other authorities, he would do so. However, after that incident and his subsequent suspension, the procedure was changed whereby the nurse was allowed, according to ACM policy, to notify FAYS first and then to notify the Centre Manager.
DR OZDOWSKI: Okay.
MR HUXSTEP: However, the colleague - the nurses that I worked with I don't think would have been - had a problem with notifying FAYS even if that wasn't ACM procedure.
DR OZDOWSKI: So the records were made directly to FAYS and what FAYS was doing when they received the record?
MR HUXSTEP: They would follow up. That was dealt with between them and DIMA, I presume, with the involvement of ACM and senior ACM people. I didn't see - I wasn't privy to that sort of information.
DR OZDOWSKI: Any final comments you would like to make?
MR HUXSTEP: Just a general comment. I think the whole concept and policy of detaining people in a prison, particularly children in the middle of the desert, is inhumane. It's demeaning and demoralising, and I think it diminishes all of us as Australians that it exists.
DR OZDOWSKI: Thank you very much, Mr Huxstep, for your evidence.
Now, could I ask Professor Margaret Reynolds to come forward. Welcome, Professor Reynolds. I would like to ask you to take an oath or affirmation.
PROFESSOR MARGARET
REYNOLDS [10.30am]
President, United Nations Association of Australia
DR OZDOWSKI: Thank you. Could I ask you, for the records, to state your name, your a