There has been lot of coverage in the media in recent times regarding the welfare of the thousands of refugees that are currently being held in offshore processing settlements, such as Nauru and Manus Island.  My view on the situation, to put it succinctly, is that every single person, regardless of race, colour, creed or circumstance should, by birthright, have access to a basic level of healthcare.

In light of the Medevac Bill being passed in February, and the increasing number of refugees integrating into rural communities in Australia, I was keen to catch up with a GP to hear how they feel the Healthcare system in Australia will need to adapt to accommodate this, and how quickly refugees will be able to acclimatise to their new surroundings. 

As it happens, my profession allows me to network with some pretty incredible people, one of those being Dr Barri Phatarfod, who over the last few years has relentlessly campaigned for improved conditions at the detention centres.  I caught up with Barri to hear her insights and expert clinical opinion.

Can you tell me more about how you came to be involved with helping refugees and how your organisation Doctors for Refugees was formed?

In 2013 Manus Island on PNG was reopened by the Australian government to indefinitely detain refugees and those seeking asylum, and later in that year the government sacked the only medical overseeing body for people in detention. At that point there were several thousand held in offshore and mainland detention centres and dreadful reports were emerging about grossly substandard care, in many cases leading to lifelong disability and sometimes death. As doctors, our code of ethics mandates that we advocate for all, with no regard to income or social group, so a few of us got together to informally review the health management provided to individuals who asked for our help, and advocate on their behalf. Within a few years, we had over 400 people referred to us. These cases included epileptic seizures, cardiac disorders, broken limbs and complicated pregnancies. Our members included specialists in the various fields so our benchmark for appropriate treatment was the Australian standard in rural and remote areas. Many of the doctors had no strong political leanings, but this was clearly a question of healthcare.

As a GP, what are the some of the most common issues you come across when consulting with refugees?

Many of these individuals are already traumatised from experiencing and witnessing events in their country of origin, often on a sustained and daily basis, so there is a pre-existing level of mental health distress. Add to this the violence and other unimaginable hardships they have faced on their journey to escape: one man watched his young child float out of his arms and disappear into the ocean after their tiny boat capsized and another young woman was raped almost daily at a refugee camp. After reaching here, they are then locked up indefinitely on a remote Pacific island where they experience a combination of poor medical care due to lack of infrastructure and political will, frequent assaults by a hostile local population and for several years are referred to by only a number, so that many young children don’t remember their own name. So, mental health disorders ranging from depression and anxiety right through to florid psychosis, self-harm and suicidality are rife. Nauru is halfway between Australia and Hawaii – it has no drinking water due to the toxic soil, and in the scorching heat many people have developed kidney stones, with one man needing a nephrectomy. The mould in the tents is highly toxic leading to a respiratory condition known as ‘Nauru Lung’, and parasitic infections such as schistsomiasis are also common, as is long-term malnutrition. The level of violent attacks such as gang rapes and machete attacks is unlike anything in Australia and the lack of justice for these assaults, while watching their friends die preventable deaths, compounds the feelings of utter despair. There are also the chronic conditions we see elsewhere, but management of these is typically very poor. Men have started to go blind from inadequately treated diabetes and developed long term brain damage due to the lack of epilepsy medications.

With an increasing number of refugees moving into rural Australia, how do you feel the healthcare system in Australia will need to adjust, if at all, to manage this?

There are many success stories of small towns facing steady decline that have benefitted enormously from the resettlement of refugees. Many refugees with a farming background adapt very easily into communities such as Mingoola on the NSW/Queensland border, and there have been projects elsewhere with similar successful results.

Acceptance from the local community has been a significant determining factor in reported well-being and recent studies have shown this is the norm, with several rural communities approaching the government with offers to house refugees, teach them English and provide jobs. Prior to the resettlement, populations were declining rapidly, school enrolments had dropped off and businesses and farmers could not find workers due to a declining working-age population. With the revitalisation of local services, communities are now in the position to attract increased funding. There is a stark disparity in healthcare between urban and rural communities, with rural residents experiencing much higher rates of injury, chronic health conditions, suicide and poverty, so an injection of healthcare funding is long overdue. The environment can be ideally suited for many refugees who may have lived most of their lives in a camp and can have difficulties navigating the complex Western healthcare system found in many big cities. Between specialists, GP referrals, outpatient appointments, the emergency department and PBS medications, sending refugees from place to place creates more confusion and opportunity for error and nonadherence. The rural settings typically encompass a well-rounded knowledge of processes within institutions that require less navigation through the layers of administration that often exist in large facilities. Access to telephone interpreter services needs to be more consistent, but overall most individuals report significantly improved health and well being by being able to live freely and most of all work and contribute to their community.

How do you feel about the new Medical Evacuation laws recently passed?

The Medevac law removes one of the main obstacles to delivering adequate healthcare offshore which is political interference in medical decisions. For too long we have seen the doctors working at these centres make recommendations for urgent transfer which have been denied by the Border Force. These doctors working in detention centres are the Australian government’s own contractors, so it is strange that their advice is viewed with such suspicion. The Coroner’s report into the death of Hamid Khazaei found this a major factor in the tragic and wholly avoidable death and recommended doctors’ medical advice be accepted. This is the norm elsewhere in the world and doctors in Australia would be horrified if they needed to check with the government whenever they wanted to send their patient to hospital. This has no bearing on Australia’s immigration policy – it is only about saving lives. Most doctors agree that border security should never be dependent on mistreating a vulnerable group of people.

We thank Dr Barri for her insights, and for the effort she, and her colleagues, commit to this important cause.