Commission Website: National Inquiry into Children in Immigration Detention
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Submission to the National Inquiry
into Children in Immigration Detention from
Michael
Hall
Nursing in a Detention Centre -
‘The Rules’
I looked up and saw a
long line of men, women and children waiting to have their blood taken. I was
standing beside a small table in a RAAF tent with a co-worker. It was 40 degrees
Celsius in the Kimberly November humidity. Both ends of our tent were open in
a vain attempt to get a breeze through as we worked side by side with flies
buzzing around our faces and hands and sweat running down our bodies. This was
my first impression of a detention centre.
It was the first time I
had been in a detention centre. I was at Curtin IRPC which stands for Curtin
Immigration, Reception and Processing Centre and is 45kms from Derby on the
mothballed Curtin air force base in the Kimberly in Western Australia's far
north. Curtin was originally established to temporarily accommodate about 300
people due to the sudden rise of boat people arrivals exceeding the capacities
of the permanent detention centres. Soon Curtin's population doubled and then
doubled again with the original detainee accommodation being supplemented with
tents. Camp development began in a frenzy and was continuing when I left over
two years later.
It was only a few years
ago that I was taking a break from my usual emergency nursing focus to be a
graduate midwife at Derby hospital. The local Path lab recruited some of us
nurses to assist them as venepuncturists at the detention centre for health
screening of new detainees. That was in late 1999. When I left Curtin for the
last time earlier this year I was the Health Services Coordinator, answering
directly to the Centre Manager and then the Health Services Manager in the Australasian
Correctional Management (ACM) Sydney Head Office. When I started we had a handful
of nurses, one locum doctor and one demountable building for us all to work
from while using detainees as interpreters. When I left we had 4 demountables,
a multidisciplinary team of health professionals and access to professional
interpreters.
Nurses are the front line
and the heart of health care in detention centres. The health manager is called
the Health Services Coordinator and this is a nursing position. Whomever fills
this position is the team leader for not only the nurses but also the counsellors,
psychologist and doctor. This person ensures that not only is health screening
done but that ongoing health care is provided. At Curtin I was lucky to be able
to develop and be a part of a team of professionals.
The nurses and others in
the health team must work in a security environment dealing with traumatised
clients of a different cultural and mostly non-English speaking background.
All health staff must be
adaptable and able to work with chronic and acute case loads daily. If you're
lucky your doctor can perform as a GP as well as an emergency physician. If
not then the nurses will, so you will need to have the skills of a remote area
nurse along with your Critical Incident skills.
Before I continue I must
comment on how politics has become an integral part of detention nursing. Not
withstanding this fact, and whatever the politics of detention are, the simple
fact remains that while mandatory detention remains government policy there
will be a need for nurses to provide quality health care in these detention
centres.
Unfortunately the Australian
community is polarised in regards to the issue of refugee versus illegal immigrant.
Some people, including friends of mine, think detention centre clients are all
Al Quida members while other people, including some other friends of mine, believe
they are all helpless refugees. Nurses don't like being the piggy in the middle.
The more we talk about nursing in detention centres the more ammunition we seem
to provide to extremists. How? Because people will tend to choose what they
remember we say. If I talk about manipulative clients or e.g. the detainee at
Curtin who I was told allegedly talked to a guard about coming terrorist attacks
in America only a week before September 11, then the One Nation supporters lap
it up. If I talk about the photographs I've seen of Taliban torture, executions
of women and children or the brutal behaviour of ACM guards and immigration
(DIMIA) officials, then the refugee activists say they are all poor refugees.
You cannot be a detention
centre nurse and not deal with politics. That is the first rule of being a detention
nurse.
Today I wanted to talk
about being a nurse. Unfortunately no one can separate the nursing role from
Party politics. Everything you do at your work, you must expect to be examined
by some human rights committee or be talked about in parliament. Leading up
to the last federal election I was constantly reminded by my superiors that
the detention issue had the potential to bring down the Federal government.
What we learnt is that it could also save the government.
The second rule of being
a detention nurse is that anyone who enters a detention centre is there because
they have entered the country illegally or violated their visa requirements.
According to the Federal government you are not a refugee until they say you
are. Processing of refugee claims are supposed to be completed within fourteen
weeks of arrival. Some take up to six months. These determinations are made
by the Department of Immigration, Migration and Indigenous Affairs - DIMIA.
Those still in detention after this time are either awaiting deportation or
are appealing their visa refusal. This issue is very relevant to the detention
nurse. You are an impartial health practitioner and are forbidden by DIMIA to
comment on visa matters. Meanwhile you need to be aware of your client’s
case status because it will influence how you deal with them and may indicate
what their state of mind may be. This information is handy for example when
dealing with suicidal clients. You are an employed by Australasian Correctional
Management (ACM). The immigration department, known as DIMIA, contracts ACM
to run the centres while still having their own officers on site to oversee
operations. As a nurse you deal with health issues not immigration issues.
Therefore the third rule
of being a detention centre nurse is to know your brief. The duties of a detention
nurse are quite clear. You are to provide for all the health care needs of your
client group while they are in detention. Your employer is a private company
so the focus begins with minimising expenditure. This strategy has developed
some limitations recently because the human rights groups and refuge advocacy
groups have learnt what specific questions to ask about a particular clients
care. DIMIA and ACM are now acutely paranoid about these groups and their influence.
Let me illustrate this point.
A disabled child arrived
one December and I was told by both an immigration and ACM manager to do nothing
for him other than what I would do for any able bodied child as he would probably
be released soon. Why should we pay for anything when the State will when he
is released, I was told. By February I am told to start organising services.
For a child who allegedly has never had any specialised care we logically started
with arranging specialist health assessments eg an Occupational Therapist assessment.
These have to be booked with the local health services with the obligatory waiting
time. In March, after the mother had complained to DIMIA about herself and her
disabled child being kept in detention, a senior ACM manager comes to a Health
Clinic staff meeting where I am abused in front of my staff for not having done
anything "since December". The lesson here is that there is no need
to provide the health care required unless there is a chance that that DIMIA
&/or ACM can come under criticism.
This also raises the interesting
point that it is actually in the interests of the ill and disabled to enter
Australia illegally because you then have a chance of a visa. Not a better chance
- A chance. If the same person applied from overseas they would have no chance
of a visa because DIMIA would simply not accept anyone that may cost them money
to provide services to e.g. health care. You may remember the gentleman who
last year set fire to himself on the steps of parliament house. He did so to
protest the fact that the government would not accept his daughter into Australia
because she has cerebral palsy. The government does not dispute this - it admits
it as it is now a vote winner.
The fourth rule of detention
nursing is that whatever DIMIA wants they get. For example ACM has a policy
that I was instructed to enforce, by my health line manager in head office,
that states that if a DIMIA official wishes to view a detainee’s medical
health record then they need to obtain the detainee’s written permission.
I informed the local DIMIA official who told me in no uncertain terms that I
was to instead do what he says. Soon the inevitable request for a medical health
record came to which I requested DIMIA provide evidence of the detainee giving
permission. In full view of ACM and DIMIA staff, as well as detainees, this
career immigration official yelled abuse at me, threatened to have me permanently
removed from the premises and then, while physically threatening me, he proceeded
to remove medical health records from the clinic. At this time I was told by
the on site senior ACM manager to give any immigration officer whatever they
wanted whenever they wanted it despite our company's policies and despite my
direct instructions from ACM Head Office.
Despite the obvious bullying
and intimidation I never got support from ACM. My health line manager did attempt
to address this issue for me but to no avail as senior ACM management do not
want to offend DIMIA. The detention contract comes first - staff are expendable.
My written request to the Nurses Board of Western Australia, hand delivered
to a Board member, about my legal responsibilities relating to health record
storage and access, went unanswered.
DIMIA will always do what
they want to do. ACM can be fined by DIMIA if there are breaches of contract.
My on site manager told me once how DIMIA was fining ACM for using detainees
as interpreters. The incident reported was allegedly when some new detainees
arrived at Curtin that the ACM manager used one of them, who could speak English,
to translate for him as he spoke to the new arrivals. What my ACM manager told
that had really happened was that it had been the DIMIA manager who had asked
the new arrivals if any could speak English. When some came forward the DIMIA
manager used them to translate for him and then gave them over to the ACM manager
to use. This was the same DIMIA manager who then fined ACM for using detainees
as interpreters. The point was pretty irrelevant for me because ACM head office
had authorised a payment schedule for detainee workers which included using
detainees as interpreters in the Health Clinic. This was despite me complaining
that it was unprofessional/unethical et cetera and that we should at least have
phone lines installed for telephone interpreters as there were (and still is)
insufficient on site official interpreters. I was ignored. DIMIA can behave
in any manner and get away with it.
My days with ACM were finally
numbered when I was posted to Christmas Island. While there I refused to be
the escort nurse for two pregnant women who were being forcibly separated from
their husbands and children so that they could be taken to the mainland to have
their babies. Their families were not allowed to accompany them because once
on the Australian mainland they would be able to apply for a visa. Breaking
up families meant that the wife would voluntarily leave the mainland to reunite
with her family. These ladies would. Especially because while on the mainland
they are kept in isolation from other detainees. They were also not told their
legal rights.
This separation and isolation
of pregnant women is wrong on so many levels: ethically, professionally, medically
- it is appalling that it could happen. But I was told later by an ACM health
manager that yes, my refusal to do the escort was a difficult ethical decision
that I had made but I'm a manager now and I have to rise above such things.
So here I have an ACM health manager I have to rise above my ethics. I have
to follow the instructions of a politician despite all the scientific research
that states such a separation at such a time for such a duration is grossly
negligent and could even be construed as abuse. I think I’ll stick to
my ethics. To top this incident off, when these ladies did arrive at Curtin,
I was asked by a DIMIA official if I was going to provide any care for them.
Ignoring the insult, I stated that just because I objected to DIMIA transferring
these women without their families, that does not mean that I would contribute
to their distress by refusing them health care. These ladies were not the problem
- DIMIA’s unethical treatment of them was.
Final rule. Everything
that goes wrong is the fault of the individual, everything that succeeds is
a result of company policy. There is a culture of blame in detention nursing
that is entrenched and unavoidable. As a detention nurse you are the classic
weak link. You are a care bear and therefore you are not to be trusted. If there
was a leak then it must have been the nurses. The detention officers will always
accuse a nurse to protect themselves even if it means being creative with the
truth.
We had a depressed detainee
who had requested to be put into a quiet room separate from others. We complied
thinking that a little time apart, with free access to his friends may be beneficial.
Unfortunately this man’s depression increased, and his appetite decreased
dramatically. He was monitored closely by the health staff and detention officers.
He was not on a hunger strike. One evening he was unwell and the detention officers
called for a nurse to visit him. Because of the man’s depression the nurse
also called the counsellor to attend. The detainee’s mouth was very dry
and although willing to drink he said he was too uncomfortable. He could not
even manage to take crushed ice. The nurse said if he was unable to drink or
eat that he may need intravenous (IV) rehydration. She was then called away
to attend someone else. After talking to the counsellor for a while the detainee
presented to the health clinic requesting intravenous rehydration. The nurse
contacted the doctor and the detainee was rehydrated.
Now if this man had been
on a hunger strike, DIMIA would have been notified. If he had refused to eat
and drink for so long that his health had been compromised the nurses would
have informed DIMIA and the doctor could have obtained permission from the Federal
Immigration Minister for permission to forcibly rehydrate him. This was not
such a case. Never the less as this man was rehydrated a detention officer rang
DIMIA and informed them that a hunger striker had been rehydrated.
The result of this ACM
officer not bothering to ask the nurse what she was doing was that the DIMIA
official stormed into the health clinic, verbally abused the nurse (in front
of detainees and other ACM staff) for not informing them about this “hunger
striker” and how dare she rehydrate him “without Ministerial permission”!
The DIMIA official then took the detainees medical health record without permission
(and while the nurse was still using it) and stormed out. The health record
was later found in the Shift Managers office where the DIMIA official had left
it lying about unattended. When ACM called an official investigation, as a result
of the DIMIA complaint about breach of process, I was told by the acting senior
ACM manager, at a managers meeting, that I was at fault but that the investigation
would be impartial. The investigating officer eventually found that Policy had
not been breached and that blame could not be put onto one person.
When the senior ACM manager
returned he discussed the issue with me. He told me not to take it personally
and that some things I just have to accept and then move on. He then went on
to inform me that the investigating officer was incorrect in his findings and
that he had informed the investigating officer what his findings should have
been and will be. These were that my nurses and I were at fault for, apart from
other things, not notifying him and DIMIA that this man was on a hunger strike.
Therefore the nurses including myself would be receiving disciplinary letters
and that DIMIA will then be satisfied that ACM had corrected the fault. This
gross manipulation of an official investigation was appalling.
To crucify someone just
to satisfy DIMIA’s complaint was unacceptable. I submitted an official
complaint about this as well as the DIMIA officials bullying and harassment
of my nurse. The new investigation (undertaken by my health line manager from
Head Office) exonerated my nurses and I but again nothing was done about the
bullying and harassment conducted by DIMIA officials.
I mentioned that I'm a
house dad now. Not a domestic engineer or such rubbish euphemism - I'm a house
dad. No I don’t find it boring. You'd think so after my doing four years
of acute A&E nursing, studying and then practicing midwifery and then being
at the coal face of detention nursing for over two years. I've actually become
a resource person for detention nurses who ring me for legal direction and yes,
emotional support.
Unfortunately there is no organisation like a Detention Nurses Association for
nurses to met with and discuss professional or industrial issues. If there are
local organisations for prison nurses then I suggest that detention nurses join
these, as well as the ANF, of course. After all detention nurses work for a
company whose main focus is gaols, as their name states: Australasian Correctional
Management. I'm finding my support role decreasing as more and more nurses who
know me leave ACM. That is not to say that the debriefing has finished. Mine
is ongoing six months later.
I'm sorry I couldn't give
a totally dispassionate speech about the joys of detention nursing. I
am here to give you my experience. There were some detainees that I wish
to never see again while there were some beautiful clients that I have
met and yes, that I miss looking after. But I have friends like myself
who were discarded by ACM when we became burnt out or perceived as a liability
just as I also have friends who have resigned in disgust at the management
practices of ACM, DIMIA and the politicians dictating healthcare. Many
nurses have been worn down by the constant harassment and bullying in
the work place from detention officers, DIMIA officials, ACM management
and also from detainees. Most of all we are tired of the fact that we
cannot give the care we wish to. In that we are just like so many other
nurses.
Last
Updated 9 January 2003.