Detained children end up mentally and physically ill. Confronted for years with the task of caring for these kids, doctors have finally howled in protest
‘The paediatricians are crying foul because they can’t go home thinking they did their best.’ Photograph: Royal Children’s Hospital Melbourne
“Your government does what with refugee children?” was the subtext of the discreet email from my friend, an American paediatric ethicist. “Thought you might be interested.”
Underneath, several international posts were attached about the protest by staff at Melbourne’s Royal Children’s Hospital against the Australian government’s policy of placing children in detention.
Of the roughly 3,600 people in detention, the latest statistics number 92 children held offshore and 113 onshore. We know physical and mental illness are not just common but the norm and when these children are finally hospitalised, they can’t be sure who they might find outside their door: the hospital clown or an immigration official.
Confronted for years with the seemingly Herculean task of providing safe, appropriate and compassionate care to these children, almost all scarred by anxiety, depression and a range of serious illnesses, a thousand doctors, nurses and other workers at one of the world’s elite hospitals finally howled in protest.
And it seemed, just briefly, that their angst and eloquence on behalf of their silent charges made a world saturated with bad news listen. Those who heard mostly lauded their stand. Even the government tuned in – although there will be no victory while the children languish in detention.
All week I have wondered what it takes for doctors, a difficult group to mobilise over any common cause, to join in protest. What does it take to attract the vocal support of usually cautious professional associations, not to mention health ministers and prominent lawyers pledging to defend any professional prosecuted for the crime (that’s right) of protesting an objectionable government policy?
When many of my colleagues, from surgeons to rehabilitation physicians, said they wished they had joined in, I realised that the protest was more than a spontaneous combustion. It was the result of a profession’s impotent rage over asylum seeker policy finally reaching its limit.
I have only ever treated one refugee child in my entire life; it was 15 years ago but I remember him as if it were yesterday. I was a volunteer at the Asylum Seeker Resource Centre, which had a rudimentary medical clinic. Our patients were ineligible for government Medicare benefits and thus completely dependent on us for medical care.
At sunset, a worried young mother brought in a little boy, no older than six. He had fallen from a swing and couldn’t move his arm. I thought he needed an x-ray to exclude a fracture. Perhaps he needed a plaster but we had neither resources nor the skill.
The nurse rightly thought that he should be seen in emergency but when she called, not a single hospital was willing to see the patient, let alone treat him, because back then, the community lived in an atmosphere of fear about what repercussions kindness to a refugee might entail.
I remember the mother’s eyes following us, her arms wrapped protectively around her boy.
“Broken?” she finally asked. “We’re not sure,” the nurse said.
At the time, our meagre donations were going into buying morphine for a refugee dying from breast cancer because she could not access routine palliative care. Rummaging around in a cupboard, the nurse gave him the left over paediatric analgesia we had. “This should help.”
“Now?” The mother didn’t need to voice her despondency.
The nurse and I looked at each other silently, suffused with the shame of knowing that we were failing our patient by letting him go with a potentially untreated fracture that could impact lifelong function. How ironic that we were surrounded by major metropolitan hospitals with billion dollar budgets who treated patients with one key difference – those patients owned a Medicare card.
I felt awful but the nurse, who was a mother herself, couldn’t bear the injustice and leapt to her feet. “Son, we’re going to find you a doctor,” she proclaimed, her plan being to find an influential friend who could evade the rules then governing the emergency treatment of “illegals”.
I thought of my day job and the hundreds of thousands of taxpayer dollars I spent on behalf of patients, with little oversight. That night, all I craved was a simple x-ray and with it, a gesture of reassurance to a mother that, despite the swirling rhetoric outside, her doctor and nurse represented only her child’s best interest.
Being forced to turn away a little boy in a first-world health system left me feeling conflicted. “What kind of a doctor am I?” I asked myself.
I wasn’t naïve enough to think that one doctor could be a patient’s saviour but this boy didn’t need complex neurosurgery or a liver transplant, just an x-ray and some pain relief. Surely, this was not too much to ask of a decent society. Now that I am a mother to young children, I recall the encounter with an added perspective that pricks my conscience.
All doctors encounter morally and ethically challenging cases. Working with refugees is emotionally consuming, and when contrasted with life in a first-world bubble, confronting. When I occasionally come across adult refugees now I indirectly meet their family. I have met children who would be in school if their parent weren’t gravely ill. I have met children who are hungry, tired and poor. It doesn’t matter that these children are free from detention, they are still worse off than their peers.
When the problem seems boundless and my efforts paltry, I focus on treating the medical illness, hoping that the diligent support workers in the hospital refugee clinic will fill in the gaps. Other providers shield themselves by assuming that political, financial and ideological motives lead people down the path of becoming a refugee.
In other words, you do whatever it takes to be the best doctor you can be in testing circumstances. Which is why the paediatricians are crying foul, because they can’t go home thinking they did their best.
They say that they actually cannot provide adequate medical care while children are held in detention and that with partial, erratic treatment it is impossible to improve their situation. They are protesting a harsh and dangerous environment where children are exposed to violence, intimidation and stressors that have a profound impact on growth and development. They are saying that chronic bedwetting, nightmares, anxiety and depression in the youngest of child refugees are not just growing pains but cause for alarm. They emphasize their duty to protect their young, voiceless patients from harm.
Cynics might see the protest as a naked political exercise but I believe that’s short-changing the thousand protesters and the invisible thousands who were there in spirit. By refusing to send their most vulnerable patients back into detention, the doctors represent the voice of a profession that has become progressively uneasy at the lack of humanity and compassion in the way Australia treats refugees.
Worse than being a refugee must be the prospect of being an ill refugee. Doctors are mostly glad to stick to medicine but it is their obligation to speak up when they are anchored by a government policy that forces them to dispense poor medicine.