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Mutually Exclusive: Refugee Health and Offshore Detention
Humanity – the condition of being human. A word that tells the stories 7.7 billion people spanning the globe. Muslim, Jewish, Christian; Asian, African, Caucasian: regardless of our creed or colour. Health is a word that goes hand in hand with humanity and is a right that should be available by all human beings, be it asylum seeker, refugee or citizen, we fundamentally intersect at the point of being human.
In many first world countries such as Australia, access to healthcare is more than often perceived as being a right rather than a privilege. But is this right necessarily extended to everyone in Australia? Well, Australia’s current offshore detention policy would illustrate otherwise. What is simply a point of political discussion for many of us, is in fact, a lived reality for the asylum seekers who experience detriments to their health whilst experiencing life in offshore detention.
Amongst the multitude of health issues faced by asylum seekers in offshore detention, the most worrying of all are the issues that go unseen. Mental health. Mental health issues are deceptively disguised as plastered smiles on hurting people, and indiscriminately plague the lives of individuals from all walks of life. However, they are often a mutually shared experience by asylum seekers and refugees in offshore detention. Alarmingly, mental health issues including but not limited to depression, post-traumatic stress disorder, and anxiety are all too common for asylum seekers. Something you might be wondering at this point is “Aren’t mental health issues already increasing in the general population anyway? Why should we pay specific attention to asylum seekers and refugees in this case?”. Well, to answer that question, let’s have a look at how much greater the risk of suffering from mental health issues are between refugees and asylum seekers, with the general Australian migrant population. Outlining just how serious the impact of immigration detention is on the health of refugees, the RANZCP reported that the rate of mental health issues in the refugee and asylum seeker population in Australia, is twice as high than in the economic migrant population. This paints a vivid picture of how the additional mental and physical traumas faced by refugee and asylum seekers have created a resultant increase in the incidence of mental health issues in this at risk population.
But how does offshore detention fit into the picture? Is it really fuelling the increased rate of mental health issues in offshore-detained refugees and asylum seekers? Or is it something else that is causing this refugee mental health epidemic? Well, I suppose one way we can answer this question, is by having a look at a 2018 systematic review of the impact of immigration detention on refugee and asylum seeker health. This review compared the severity of mental health issues between detained and non-detained asylum seekers. Rather unsurprisingly, what the study found was that asylum seekers who were detained suffered from comparatively more severe cases of mental health issues than those who were not detained.
Understandably, the issue of immigration detention in Australia is extremely complex and multifaceted. Economics, logistics and politics feature heavily in this issue. Whilst the health of refugee and asylum seekers is only one of the many faces of immigration detention, placing humanity at the forefront of discussions surrounding this is important. At the end of the day, when we talk about refugees and asylum seekers in immigration detention, we are talking about the lives of individual human beings. Mothers, sisters, and daughters. Fathers, brothers, and sons.
MEDICAL STUDENTS MARCH FOR REFUGEES
But as any good parent, teacher, or mentor would have told you growing up, actions speak louder than words. So now that we know that offshore detention is the metaphoric cannon fodder for the refugee and asylum seeker mental health crisis; what is being done to prevent this cannon from firing? Well, to put things simply, Marches in April. Terrible puns aside, multiple marches advocating refugee rights and health took place during the month of April in all capital cities in Australia. Medical students in each state took their stand against offshore detention to fight for the health rights of refugees.
On April 14, medical students from the University of Notre Dame, UWA and Curtin University put their inter-collegial rivalries aside to take part in Perth’s rendition of the Palm Sunday March for Refugees. The participation of medical students in this march, whilst seemingly inconsequential, played a role in reinforcing the notion that the right to health should be universal – and that individuals should not be deprived of this right just because they are asylum seekers or refugees.
It is the hope that medical student involvement in refugee health advocacy will one day help to deinstitutionalise the healthcare detriments and disparities faced by refugees and asylum seekers in offshore detention.
Obstetrics
Sita, a paramedic at the Poilarkandi Health Clinic, in Bangladesh performs an antenatal care check up on expectant mother Rohima. Rohima, 22, lives in Poilarkandi village and has come to the clinic for her first antenatal appointment at five months pregnant. Photo: CJ Clarke/Save the Children. Accessed at https://www.healthynewbornnetwork.org/blog/photo-of-the-week-ensuring-safer-pregnancies-with-antenatal-care/
Obstetrics in FOCUS
Every six minutes, approximately three women die from preventable causes related to pregnancy and childbirth.
Almost all of these deaths (99%) occur in developing countries, and are considered preventable.
Complications from pregnancy and childbirth take a huge toll on the young and are the leading cause of death among teenage girls in developing countries. (World Health Organisation).
Why do women die?
The most common causes of maternal deaths are:
- Postpartum haemorrhage
- Infection
- Eclampsia
- Complications from delivery
- Unsafe abortion
In most cases, these conditions can be prevented in the first instance by sex education and access to contraception, as well as consistent antenatal care and safe and sterile birthing conditions.
From antenatal care through to post-partum we have compiled the internet’s most interesting resources, to educate and inspire you to take action on maternal health.
Fact Sheets
http://www.who.int/mediacentre/factsheets/fs348/en/
TED TALKS
Doula and journalist Miriam Zoila Pérez explores how race and gender affect maternal and foetal outcomes and class and illness and informs us about a radically compassionate prenatal care program to reduce the stress experienced by pregnant women of colour.
https://www.ted.com/talks/zubaida_bai_a_simple_birth_kit_for_mothers_in_the_developing_world
Product developer Zubaida Bai talks about the development of a clean birth kit in a purse, a powerful tool to reduce the rates of post-partum infection in the developing world
Everyday Emergency: The Medicins San Frontieres (MSF) Podcast
Have you ever wondered what a day looks like for doctors who practice obstetrics in resource poor communities? In “Everyday Emergency” we hear from two doctors faced with extreme clinical challenges as they attempt to facilitate safe childbirth amidst extreme poverty and fatal disease outbreaks.
NB: These episodes are great for revision of step-by-step management of obstetric emergencies!
Disclaimer
This series can be pretty confronting and heart breaking at times. If you’re feeling a bit vulnerable or overwhelmed, put it on your list for another day.
S1 E1: The First 24 Hour Shift by Everyday Emergency
Dr Benjamin Black discusses his first 24-hour shift; where he found himself performing an emergency hysterectomy in the midst of an Ebola outbreak.
Hooked? You can read more from Dr Black on his blog “May the Forceps Be With You”
http://blogs.msf.org/en/staff/blogs/may-the-forceps-be-with-you/before-the-beginning
http://blogs.msf.org/en/staff/blogs/may-the-forceps-be-with-you/state-of-emergency-0
S1 E6: Precious Baby by Everyday Emergency
Dr Veronica Ades describes the precarious situation for expecting mothers in South Sudan, an area with some of the highest foetal and maternal mortality rates on earth.
“Does she just have incredibly bad luck in a setting with extremely poor access to obstetric care? Maybe the three previous stillbirths were unrelated. So many women here have stillbirths or neonatal deaths, and there is no consistent reason. Regardless, I have to do everything I can to ensure that this child survives.”
Careers
Have we got you interested in in a career as an Obstetrician/Gynaecologist? You can find out more about the training pathway here:
https://www.ranzcog.edu.au/Training/Specialist-Training
Infectious Disease – Part 2: Outbreaks – Ebola and Zika Virus
OUTBREAKS in FOCUS – Ebola and Zika
In 2014, West Africa experienced the largest outbreak of Ebola virus in known history. Over a
two year period, this severe and rapidly fatal disease claimed the lives of over 11,300 people,
including over 500 health workers.
The international community was not prepared for such an outbreak. As a result, health services struggled to contain the epidemic, which spread to six countries (Liberia, Mali, Guinea. Sierra Leone, Nigeria and Senegal).
The outbreak (and the world’s slow response to it), highlighted the need for better international public health policies and a more sophisticated disaster response, globally.
This week, we are putting the focus on Ebola, and have curated resources to help you better understand this deadly virus. and it’s impact on West Africa.
We also touch on Zika Virus, a vector borne virus linked to neurological syndromes like Guillian-Barré and microcephaly. This disease was first identified in 1947, but caused international concern in 2015 when an outbreak occurred in Brazil.
Intrigued? Check out the links for fact sheets, fascinating accounts from health workers at the front line, and insights into what the world has learned from such a devastating epidemics.
First though, have you ever wondered where it all begins?
Podcast: RadioLab -Patient Zero Updated, Season 13 Episode 3
How do you find the Patient Zero in an outbreak? What information does that give us in our bid to control a disease outbreak? Explore the concept and implications with this podcast, that discusses the iconic case of Typhoid Mary, the controversial origins of HIV, and the recent emergence of Ebola in West Africa.The extras section goes into more detail about Ebola’s patient zero.
http://www.radiolab.org/story/patient-zero-updated
http://www.radiolab.org/story/patient-zero-extra-ebola/
EBOLA
Fast Facts
KILLER DISEASES | How the Body Reacts to Ebola
EBOLA | Looking Back on the Deadliest Outbreak in History
Bill Gates: The next outbreak? We’re not ready
Tech genius and philanthropist Bill Gates talks about how we should be using technology to better equip ourselves for the next deadly outbreak.
Interactive Map of Ebola Outbreak – Frontline
http://www.pbs.org/wgbh/frontline/article/map-how-the-ebola-outbreak-spread-through-africa/
Longer Listen
Documentary – Outbreak -Frontline PBS documentary (2015) http://www.pbs.org/wgbh/frontline/film/outbreak/
Documentary – Affliction – MSF Ebola documentary – See trailer at http://afflictionfilm.com/
Everyday Emergency: The Medicins San Frontieres (MSF) Podcast
Disclaimer
This series can be pretty confronting and heart breaking at times. If you’re feeling a bit vulnerable or overwhelmed, put it on your list for another day.
Vision Recommended Episodes
S1 E9: I Had to Turn People Away from the World’s Largest Ebola Centre by Everyday Emergency
Anthropologist and health promoter Pierre Trbovic travelled to Liberia to assist MSF in the fight against Ebola. In August 2014, the crisis in Liberia hit it’s peak and services were quickly overwhelmed. Here, Pierre speaks about his most difficult role; turning suffering patients away from the Ebola management centre in Monrovia, Liberia.
ZIKA
Zika is a disease spread by the Aedes mosquito, found in many tropical counties. Although the symptoms of Zika are usually mild and require no specific treatment, the world became fascinated by this disease in 2015, when it was concluded that Zika virus during pregnancy could cause unborn children to develop severe congenital brain disorders.
Since then, evidence has emerged that Zika may also be sexually transmitted and can cause neurological disease in adults too.
Read on for the latest information on this disease as well as the fascinating science behind the attempts to control it.
Fast Facts
WHO Factfile – http://www.who.int/mediacentre/factsheets/zika/en/
WHO- Historical Distribution Map of Zika Virus – Click on the image below to enlarge.
Talks
BMJ Talk Medicine- Zika Virus- “It really felt like having bad sunburn, all over your body”
Available at https://soundcloud.com/bmjpodcasts/zika-virus
TedTalk – Nina Fedoroff –“A Secret weapon against Zika and other mosquito-borne diseases”
Available at http://bit.ly/2qAoiTb
Infectious Disease – Part 1: Tuberculosis
Left: Mycobacterium Tuberculosis bacteria1 Right: A patient in Lesotho with multidrug-resistant tuberculosis3
TB in FOCUS
For many of us in the Western world, Tuberculosis (TB) is often thought of a disease of the past. However, TB is very much a current health issue for people living in developing countries, with 10.4 million new cases diagnosed every year3. Although TB is both preventable and treatable, it is currently the world’s most deadly infectious disease.
Did you know that over 1.8 million people are killed by TB every year?
This disease kills more people that HIV and malaria.
Alarmingly, cases of drug resistant TB are on the rise. As TB is predominantly seen as a disease of the poor, there is little incentive for researchers and drug companies to develop more effective diagnostic tests and treatments. Many governments continue to use outdated practices to the detriment of their patients.
Want to know more? Check out our list of curated resources to educate, inform and inspire you to join the fight against this devastating disease. From podcasts for your morning commute, to books for your summer holidays – Vision Global Health has you covered.
Everyday Emergency: The Medicins San Frontieres (MSF) Podcast
In this podcast series by Medicins Sans Frontieres/Doctors Without Borders, health workers tell their true stories from the front line of humanitarian medicine. The content is both reflective and jammed-packed full of gritty medical detail.
What it’s great for:
Revision, inspiration and understanding how social and political conflicts influence disease.
Where you can get it:
https://www.msf.org.uk/everyday-emergency-msf-podcast or enter “Everyday Emergency” into your nearest podcast provider.
Disclaimer
This series can be pretty confronting and heart breaking at times. If you’re feeling a bit vulnerable or overwhelmed, put it on your list for another day.
Vision Recommended Episodes:
Season 2, Episode 1: “My fight isn’t over.- World TB Day”
“One, two, three… 12 last pills. In the past two-and-a-half years, I have had to swallow close to 15,000 tablets. What started off as regular tuberculosis, morphed to a stronger resistance and after five months, I was put on multidrug-resistant TB drugs. As if this killer disease was on a rampage for my family, my three-year-old younger child, John, became very ill too…”
Elizabeth Wangeci’s story is a remarkable one. Against the odds, Elizabeth, from Nairobi, was the first person to survive one of the deadliest forms of drug-resistant tuberculosis in Kenya.
In the first episode of the second series of Everyday Emergency, and on World TB Day 2017, we hear from Elizabeth nearly one year after being cured. We also hear from Mark Sherlock, an MSF TB doctor who works not far from Elizabeth in Nairobi
***
Season 1, Episode 4: “The Darkest Hour”
“The last 13 years of my life have been dedicated towards turning me into a finely tuned and rational life-saving machine. I am not supposed to form emotional attachments to my patients or hold them passively and powerless while they die. I’m supposed to secure their airways, stabilise their blood pressures and attach them to life-support machines. But this is the reality in which I find myself: my favourite patient lies dying in my arms.”
In this episode we meet British doctor Emily Wise who, in 2013, travelled to Uzbekistan – a country with particularly high drug-resistant tuberculosis rates. In ‘The Darkest Hour‘, Emily describes in heartbreaking detail the final minutes of a TB patient’s life.
***
Season 2, Episode 7: “All I need is a metre of rope.”
“Twenty months of treatment? Fifteen to 16 tablets a day, right? No, I would rather die. All I need is a metre of rope.”
Despite ranking alongside HIV as the leading cause of death by infectious disease, the global response to TB has been found wanting.
Because the drugs used in standard treatments have not changed in over 40 years, they are becoming less and less effective due to increasingly high levels of resistance from the bacterium. In the seventh episode of Everyday Emergency, Australian doctor Amrita Ronnachit discusses her time battling TB in Uzbekistan, and the case of one patient who struggled with his treatment.
*All summaries are taken from MSF.org.uk
Mountains Beyond Mountains by Tracy Kidder
This Pulitzer Prize winning biography chronicles the remarkable life of Dr Paul Farmer: a Harvard graduate, infectious diseases physician, anthropologist and human rights activist. In this book, we follow Farmer as he builds clinics in some of the poorest areas of Haiti, undertakes a medical degree at Harvard and goes on to be one of the most important public health reformists of our time. From the slums of Haiti to the prisons of Russia, this book provides insight into the devastating effects of drug resistant TB and the brilliant work NGOs are doing to address health problems that are neglected by many governments.
What it’s great for:
- Reflecting on the moral, philosophical and medical challenges of working in a world where health resources are not equitable.
- Insight into how NGOs are formed and the challenges they face.
Where can I get it?
Download on iBooks or get in touch with the excellent people at Boffin’s Bookstores. https://www.boffinsbooks.com.au/books/9781846684319/mountains-beyond-mountains-one-doctors-quest-to-heal-the-world
Blogs and Articles
Need more information? Get the facts and figures here:
http://www.who.int/tb/post2015_TBstrategy.pdf?ua=1
https://www.msf.org.uk/issues/tuberculosis
https://www.pih.org/article/new-drugs-are-a-new-hope-against-tb-in-peru
Careers
Have we got you interested in in a career as an Infectious Diseases physician? You can find out more about the training pathway here: https://www.racp.edu.au/trainees/advanced-training/advanced-training-programs/infectious-diseases
Campaigns
Wondering what you can do to help right now?
Head to http://stepupfortb.org/activist-toolkit to find out how to be a TB activist.
References
- http://stateschronicle.com/wp-content/uploads/2013/09/Mycobacterium_tuberculosis_14313982_1.jpg
- World TB Day: A Q&A With Expert Carole Mitnick. (2013). Partners In Health. Retrieved 3 September 2017, from https://www.pih.org/article/world-tb-day-expert-carole-mitnick-on-drug-development-treatment-models-and
- Tuberculosis (TB) Fact Sheet. (2017). World Health Organization. Retrieved 3 September 2017, from http://www.who.int/mediacentre/factsheets/fs104/en/
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