Health service provision in the Torres Strait
3.1
In the previous chapter, the committee outlined the Treaty provisions
and referred briefly to concerns arising from them. In this chapter, the
committee examines health issues in the Torres Strait region. While health and
the provision of medical care are not matters directly covered by the Treaty,
the free movement provisions have contributed to a situation where public
health and access to health services have become significant issues in the region.
3.2
The committee starts its examination by looking at the nature and extent
of local concerns associated with PNG traditional inhabitants visiting the Torres
Strait to receive medical attention. It then seeks to establish why some PNG
visitors choose to access health services in Australian health clinics rather
than those available in their own country.
Access to health services under the Treaty
3.3
The Treaty allows traditional inhabitants from the PNG Treaty villages
the freedom to enter the Torres Strait Protected Zone and stay temporarily to
perform traditional activities. They are not subject to the same immigration,
customs, health and quarantine requirements and checks as PNG citizens who are
not traditional inhabitants. The Treaty defines traditional activities and
lists the activities that come under this definition. Access to health
services, however, is not classified as a traditional activity. The
Guidelines for Traditional Visitors indicate clearly that a visit to a
medical clinic is a non-traditional activity.[1]
Thus, any traditional inhabitant from PNG seeking to gain entry to Australia
for medical reasons is not entitled to benefit from the free movement
provisions and must satisfy Australia's immigration laws.
PNG traditional inhabitants visiting
island health clinics
3.4
Although using health services is not included under the freedom of
movement provisions, every day, PNG nationals travel cross the border to
receive treatment at one of the island health clinics, particularly those
located on Saibai and Boigu. The Torres Strait Island Regional Council (TSIRC) informed
the committee that there are 13 Western Province communities plus an additional
16 communities outside the Treaty zone that access health facilities in the
Torres Strait.[2]
Mr John Toshi Kris, Chairperson, TSRA, told the committee that island communities
are being 'inundated' with people coming across with medical issues.[3]
3.5
Data on the number of PNG nationals seeking medical assistance in the
Torres Strait is incomplete due to problems recording the exact nature of
visits. The TSRA suggested that 'DIAC and Queensland Health estimates of
unregulated health service use are perhaps conservative'. It noted:
Few people are likely to declare that medical treatment is a reason
for their visit if it is illegal; also, clinic staff may not report visits on
minor medical matters and instead deal with them as part of their routine
day-to-day business.[4]
3.6
Indeed, the Department of Immigration and Citizenship (DIAC) noted that
according to health care consultants, medical treatment may be a primary rather
than a secondary factor in some 'traditional' visits.[5]
3.7
Despite questions about the accuracy of the data, without doubt, the
number of PNG nationals receiving medical treatment in the Torres Strait is significant.
On average, PNG nationals make around 2,500 visits to Torres Strait island
health clinics every year.[6]
For example, in 2007–08, there were 2,350 presentations on Saibai and Boigu.[7]
Considering that Saibai and Boigu each have a population of around 300 people,
PNG visitors make up a large proportion of the people residing on an island.[8]
In addition, according to TSRA, some PNG traditional inhabitants stay on the
Torres Strait islands or in Cairns or Townsville hospitals 'for up to nine
months'. This is mainly a result of tuberculosis treatment requiring 'at least
six months of intravenous treatment'.[9]
3.8
Ms Bronwyn Nardi, Queensland Health, noted that although there were some
issues around data collection, the district chief executive officer had compared
figures for the first three months of 2009 with the first three months of 2010
and found a 300 per cent change from the quanta. However, a change of this
magnitude is probably an anomaly caused by fewer PNG nationals seeking health
care at Torres Strait health clinics in 2009 as a result of the swine flu epidemic
and the temporary closure of the border.[10]
3.9
As a matter of interest, Ms Nardi recorded that on Wednesday, 24 March
2010, 60 per cent of the inpatients in Thursday Island hospital were PNG nationals,
which, in her view, was 'not unusual'.[11]
Also, demographic and medical information collected by Queensland Health on
patients presenting at their specialist mobile units in the Torres Strait
indicate that PNG nationals account for over 99 per cent of presentations at
these clinics.[12]
It should be noted, as explained by Ms Nardi, that Queensland Health has no
control over the volumes that are coming through the border to its healthcare
facilities, and that demand for healthcare services from PNG nationals appears to
be rising.[13]
Concerns about PNG nationals accessing health services in the Torres Strait
3.10
During the inquiry, including the committee's visit to the Torres
Strait, the committee learnt of numerous worries regarding PNG nationals visiting
island health clinics. The committee turns to examine each of these in detail.
Strain on local resources
3.11
Local inhabitants were concerned that PNG nationals receiving treatment
in the Torres Strait place 'a lot of strain on infrastructure and communities'
and restrict local residents' access to health professionals.[14]
For example, the TSIRC noted that limited doctor availability 'sometimes mean
that legal residents do not have access to health professionals because their
time is spent on PNG Nationals'.[15]
3.12
Community leaders on Saibai and Boigu informed the committee that their
people, particularly the elderly, feel as though they are missing out on access
to health services.[16]
Some pointed to the high number of Thursday Island hospital beds occupied by PNG
nationals with tuberculosis, which, in their view, affects access to services
by locals.[17]
Queensland Health statistics support this view, indicating, as stated earlier,
that it is not unusual to have 60 per cent of the inpatients in Thursday Island
hospital from PNG.[18]
3.13
Ms Nardi noted the rising demand for healthcare services from PNG nationals
and the concerns relating to the shift 'of funding for the provision of health
care from Torres Strait Australians to Papua New Guinean nationals'.[19]
She indicated that 'it is feasible that around 10 per cent' of the Queensland
Government's Torres Strait Islands health budget of $58.5 million is diverted
to PNG nationals (approximately $6–6.8 million).[20]
She noted:
While we are providing acute care for Papua New Guineans,
that means there are other services that are not being provided—things like increases
in primary health care and public health.[21]
3.14
Acknowledging these concerns, Queensland Health pointed out that while
PNG nationals may access some services, there are many that they can not.[22]
The committee also learnt that the waiting time to see a specialist on Torres
Strait Islands is shorter than on the mainland and that there is no obligation
on the health workers to accept referrals from PNG.
3.15
Even so, the strongly-held perception in the region remains that
significant numbers of PNG nationals are receiving medical treatment, which
inevitably affects the quality of service available to local people.
3.16
Furthermore, the TSRA was of the view that these visits by PNG nationals
to Torres Strait health facilities also place 'a silent burden' on infrastructure,
education and welfare services.[23]
For example, the increased demand for the limited supply of water and
sanitation infrastructure, particularly during the dry seasons, could produce
additional health concerns.[24]
Transmission of communicable
diseases
3.17
As well as the strain on medical resources and vital infrastructure
associated with promoting good health, a large number of submissions referred
to the prevalence of communicable diseases in PNG and the risk of their
transmission to Australia. The TSRA drew attention to local inhabitants and
their increasing concern that diseases, including HIV/AIDS and dengue fever,
are entering Torres Strait Islands via the movement of PNG nationals.[25]
Community leaders on Saibai also spoke to the committee about their people's
fear of contracting infectious disease.
3.18
The most worrying diseases present in PNG are malaria, tuberculosis
(TB), sexually transmitted infections (STI) and HIV/AIDS.[26]
For example, in March 2009, the rate of tuberculosis in Western Province, the
PNG region closest to the Torres Strait, was 552 cases per 100,000 people.[27]
Indeed, the most common reasons for health visits by PNG nationals to the Saibai
health clinic were tuberculosis and malaria.[28]
The following statistics record the medical conditions of PNG nationals treated
by the Saibai health clinic over the 2006–2007 period.[29]
Table 3.1: Reasons for health visits of PNG nationals to
the Saibai health clinic, 2006–2007
|
Reasons for
Presentations |
2006 |
2007 |
|
Other Problems |
20% |
19% |
|
Doctor/Specialist
review |
11% |
8% |
|
TB medication/confirmed
TB |
10% |
16% |
|
TB investigation |
10% |
11% |
|
Post Treatment Review |
9% |
n/a |
|
Aches and Pains |
n/a |
9% |
|
Surgical Elective Cases |
n/a |
8% |
|
Prescriptions |
n/a |
8% |
3.19
The freedom of movement provisions, which exempt traditional inhabitants
from the usual immigration health checks at the border in the Torres Strait,
add to the fear of likely transmission of serious diseases. Unauthorised
visitors who manage to land on the islands undetected also increase the risk of
diseases being transmitted to people on the islands. These visitors cannot be
monitored in a similar manner to authorised entries who are registered at the
designated immigration entry points.
Tuberculosis
3.20
Tuberculosis presents a particular problem for the Torres Strait. Ms
Nardi explained that diseases such as tuberculosis, which essentially have been
controlled in Australia, are crossing the border from PNG. She noted further that
while tuberculosis can present as an acute illness, it requires lengthy
treatment that can last about six months.[30]
3.21
Evidence to the inquiry made clear that appropriate and thorough
treatment of tuberculosis is of vital importance. If the treatment is not
completed or administered incorrectly, tuberculosis may build up a resistance to
drugs, requiring stronger and more expensive medicines to treat effectively. This
form of tuberculosis may not only spread as a drug-resistant disease but eventually
as a multi-drug resistant tuberculosis (MDR TB).[31]
Health workers in the Torres Strait are conscious of the potential for the
transmission of MDR TB.[32]
Limited surveys estimate that between 10 and 20 per cent of tuberculosis in PNG
could be MDR TB.[33]
Ms Nardi stated that 'we know that in Papua there is an extreme drug resistant
tuberculosis which is essentially a death sentence'.[34]
3.22
According to Ms Nardi, the Torres Strait Islanders are 'genuinely concerned
about these severe and exotic illnesses coming into their community'. She noted
that the incidence of PNG nationals returning home and failing to maintain
their drug regime was 'common enough'. Ms Nardi underlined the need to treat diseases
like tuberculosis appropriately so they do not extend into Torres Strait
communities and then spread to the mainland.[35]
3.23
Another communicable disease raising significant concern amongst Torres
Strait Islanders is HIV/AIDS, which is the leading cause of deaths in some PNG
districts.[36]
The Department of Health and Ageing (DoHA) informed the committee that PNG has
the highest incidence of HIV in the Pacific region, with an estimated two per
cent of the adult population, or approximately 64,000 persons, being HIV
positive.[37]
The epidemic is concentrated in seven highlands and central provinces and along
the Highlands Highway.[38]
Limited transportation options and thus movement of people have to date
contained the spread of the disease.[39]
3.24
Despite the lack of comprehensive data, the prevalence of HIV/AIDS in
Western Province is estimated to be low.[40] This information seems to
be supported by information provided by AusAID that indicates that only seven
cases have been diagnosed in Daru and these have been people who had contracted
HIV outside Western Province.[41]
Further, DoHA informed the committee that on average, one case per year amongst
PNG nationals is diagnosed at the health clinics.[42]
3.25
Although the presence of HIV/AIDS is low in Western Province, DoHA
observed that the disease continues to be an issue that needs careful
management.[43]
For example, the situation could change considerably with the construction of a
highway from the South Fly district towards the Indonesian border in Western
Province. This development is expected to increase the movement of people, including
that of 'mobile men with money'.[44] Some medical experts have
suggested that road construction projects should be accompanied by 'very
rigorous HIV prevention programs' in order to educate the people and to
minimise the risk of HIV/AIDS spreading.[45]
3.26
The terms of reference for AusAID's evaluation of Australia's
contribution to the national HIV response in PNG made a similar reference to
the potential for HIV/AIDS to spread because of increased people movements and
activity associated with infrastructure projects.[46]
The committee considers that this evaluation, provides an opportunity for AusAID
to consider developments in PNG's Western Province and the likely exposure of
the Treaty villages to this disease. It therefore suggests that the Office of
Development Effectiveness include Western Province, in particular the 13 Torres
Strait Treaty villages, in its evaluation of Australian aid program's
contribution to PNG's national HIV response.
3.27
While the prevalence of HIV/AIDs in the southern part of PNG is low at
the moment, the committee recognises that health professionals in the region
are concerned about the potential transmission of the disease. Fortunately, at
the moment, the incidence of HIV/AIDS is almost non-existent in the Torres
Strait Islands, with only three confirmed cases.[47]
Dr Patricia Fagan told a House of Representatives Committee that there was 'no
known local transmission of HIV among the people of Cape York and the Torres
region'.[48]
3.28
The Queensland Government informed the committee that the spread of
HIV/AIDS to the islands 'to this point has proven not to be as significant as
initially anticipated'; but it was aware that cross-border movements complicate
the situation.[49]
Experts agree that 'the soil is very fertile' and that Torres Strait Islanders
'are extremely vulnerable to an HIV epidemic'.[50]
3.29
The potential for co-infection of tuberculosis and HIV is an added
problem. The high rate of HIV infections can undermine the effective management
of tuberculosis because tuberculosis and HIV interact, making 'each other worse'.[51]
Even though the number of co-infection cases is very low, the survival rate is
also low.[52]
Other communicable
diseases
3.30
Malaria is another communicable disease causing concern in the Torres
Strait region. It 'remains a serious health problem' in PNG, where it is 'the
third leading cause of hospital admissions and deaths'. In 2007, there were 87,961
confirmed malaria cases in PNG, of which 594 resulted in deaths. However,
malaria in PNG is thought to be contained, even though its prevalence in
Western Province is not monitored.[53]
This would appear to be supported by the statistics from the Torres Strait: the
number of confirmed malaria cases presented at the Saibai health clinic between
2006 and 2008 had declined from 20 cases in 2006 to six in 2008.[54]
3.31
Apart from human-to-human transmission, there are other means through
which diseases enter the islands. The committee considers these concerns in
greater detail in the chapter on biosecurity. The committee now turns to
examine the reasons PNG citizens seek health care on the Torres Strait Islands.
Incentives for seeking medical care in the Torres Strait
3.32
The occurrence of communicable diseases in PNG together with the free
movement of people creates genuine grounds for concern. The core question
before the committee is why PNG nationals are travelling away from their homes
and communities to access health services in the Torres Strait. The following
section explores some of the main reasons.
Disparity in available health services
3.33
Many witnesses cited the large disparity between the quality of health
services in Western Province and in the Torres Strait as a major incentive for
PNG nationals to seek medical treatment on the Australian side of the border.
For example, Ms Nardi noted that health care in the Torres Strait is in demand
because 'the health services in Papua New Guinea are of a lesser, lower
standard and the services that are offered in the Torres Strait are of a higher
standard—there is a confidence in them'. She explained:
I think we are seeing that Queensland Health is suffering
from being a downstream type arrangement from what is a failing healthcare
system in the Papua New Guinean area.[55]
3.34
Indeed, 'PNG has one of the poorest health records in the Pacific and is
unlikely to meet any of its health-related Millennium Development Goals'
(MDGs).[56]
None of its health sector indicators has improved since 2002. Evidence
indicates that: 'Communicable and often easily preventable diseases are the
most common causes' of death, with two in five deaths caused by 'six diseases
that can be easily and inexpensively treated' at aid posts.[57]
3.35
The World Health Organization's (WHO) Country Health Information Profile
on PNG for 2009 provides some insight into the state of health facilities in
the country and the health care services available to Papua New Guineans,
especially in rural areas. With regard to health facilities, it recorded that:
A function and expenditure review in 2001 described the
health system in rural areas as being in a state of 'slow breakdown and
collapse, currently being saved from complete collapse by donors'...'About 600
rural facilities are closed or not functioning effectively. Where services
remain, the breadth and quality of the services are diminishing'. This dire
situation has worsened since then, and more facilities have closed down. In
spite of this being acknowledged for some time, little has been done yet to
seek redress.[58]
3.36
The information profile noted that while nurses and community health
workers form the backbone of primary health care services in rural areas, both 'are
considered to be in short supply and dramatically reduced'. For example, it
noted that the nurse-to-population ratio was estimated at 1:2271, stating
further:
An additional 600 nurses, 600 community health workers and
100 midwives are estimated to be needed to fill vacant posts, but current production
rates are insufficient to fill the gaps. The doctor-to-population ratio is
estimated at 1:19 399 population, the majority of doctors being in Port Moresby.[59]
3.37
Some provinces and many districts have no doctor. Ms Nardi observed:
To be perfectly honest, there are horrendous things coming
out of Papua New Guinea that we are looking after in the Torres Strait that
really indicate that the health of that nation truly needs some attention...[60]
Reasons for poor state of health
services in PNG
3.38
The reasons for the poor state of health facilities in PNG and the
shortfall in capacity to meet the health needs of its people are varied and
complex. The nature of settlement in PNG, with widely scattered rural
communities separated by difficult terrain, makes the provision of health
services on the ground difficult and expensive. Some villages can only be
reached on foot. Also, according to the WHO, spending on health is falling in
PNG despite its high share of government funding. It noted that 'total health
expenditure as a share of Gross Domestic Product (GDP) rose steadily from 3.2
per cent to 4.4 per cent between 1997 and 2001'. In 2007, it fell back to 3.2
per cent, with total health expenditure per capita declining to US$31.3 from
US$32 in 1997.[61]
3.39
The administration of finances, including the prioritisation and
allocation of funding between the central and provincial governments, is a
major impediment to the effective delivery of health services.[62]
Capacity constraints and weak governance, including lack of accountability,
coordination and leadership in the delivery of health services, is a further
complication.[63]
Criticism has been directed at the 'lack of flexibility around the use of the
funds', including in emergencies, and the disregard of funding priorities in
some provinces.[64]
As a result, funding may not always reach its target. According to AusAID,
these constraints between central and provincial governments in PNG result in a
'large amount of the money [left] unspent'.[65]
In addition, 'The late and sporadic release of funds has led to serious delays
in activities' and exemplifies the problems regarding allocating funds to where
they are most needed.[66]
Provinces also face the challenge of managing two different sources of funds,
from the PNG Government and donors, each with different sets of rules and
procedures.[67]
3.40
Another impediment to improving the PNG health system is its changing
funding arrangements, in particular, the 'transfer of control over
supplementary funding for infrastructure from the National Department of Health
to the National Department of Planning and Monitoring'.[68]
3.41
Evidence suggested that despite funding shortfalls, Western Province has
sufficient financial resources to fund its health services as a result of
resources from mining revenues.[69]
According to AusAID, the revenue flows to Western Province 'are substantially
above that required to fully fund basic services, including health'. It noted
that royalties and dividends from the Ok Tedi mine to the Western Province
Administration are projected at K60 million in 2010. However, it also indicated
that the total health revenue of Western Province 'is difficult to estimate as
funding comes from multiple sources'. Despite the apparent availability of
funds, AusAID informed the committee that in 2005–2008, the province was said
to have spent '59 per cent of what was necessary to deliver basic health
services'.[70]
Health services in the South Fly
District
3.42
For this inquiry, the health situation in the South Fly District of
Western Province, which is adjacent to the Torres Strait, is of particular
relevance. Not only does this region suffer from the same shortage of health
facilities and workers that affect PNG as a whole but, as a remote rural area,
it faces even greater problems. DoHA explained the challenges confronting the
district:
PNG villages...face pressing health concerns brought about by
poor sanitation, poor water quality and limited disease control. Local health
services suffer from inadequate infrastructure, shortages in staff and clinical
supplies and have limited diagnostic capacity.[71]
3.43
Mayor Frederick Gela, TSIRC, told the committee that it was evident that
'the villagers who access the Treaty arrangement have been neglected for
years—for generations'.[72]
Dr Garrick Hitchcock, an academic with extensive experience in the Torres
Strait region, said that the region does not have resources such as timber,
oil, gas or minerals; the southern area of Western Province is 'the
backblocks', 'off the beaten path and very peripheral'. He suggested that the people
would do whatever they could to try to improve their standard of living and
health care and are looking elsewhere.[73]
Dr David Lawrence, another academic who has researched the Torres Strait
region, spoke similarly of the very poor standard of health care on the PNG
side of the border. He described the region as 'the most marginalised province
in Papua New Guinea and basically in Port Moresby it is seen as rubbish country...not
considered to be terribly useful, productive or important'.[74]
In his assessment:
Their access to health, education and welfare is just
appalling. Daru has a population—sometimes it fluctuates—of about 13,000
people, so just the Daru Island has more people than the whole of the
Australian side of the Torres Strait. It has one hospital. We do not even know
that there is actually one doctor for the whole of the Western Province.[75]
3.44
DoHA submitted that the Daru hospital requires major infrastructure
development but also that the quality of clinical services, management and
governance issues needs to improve.[76]
Furthermore, it noted that the clinical outreach services from Daru hospital
lack the capacity to support rural areas: for example, access to maternal and
child health outreach services in most cases had not been functioning at all in
remote communities. It stated that the non-functioning of these services means
that family planning, immunisation for young children, antenatal screening,
health education and awareness are not available. DoHA suggested that as a
result of these poor outreach health services, people in these communities tend
to prefer to use the freedom of movement provisions to access health services
in the Torres Strait.[77]
Community leaders on Saibai were of the view that with the lack of facilities
on Daru, people were being referred to the Torres Strait in increasing numbers.[78]
Indeed, the TSIRC claimed that health officials in Daru encouraged PNG
nationals through referrals to visit Australian health clinics and timed these
visits 'perfectly' with the visits to the islands by specialist doctors.[79]
Overall, the TSRA noted:
Given the desperate condition of infrastructure and health
care services in the Western Province of PNG, where they have little prospect
of adequate treatment, these people may be regarded as 'medical refugees'.[80]
Accessibility to Torres Strait health clinics
3.45
A second reason for PNG nationals from the region choosing to seek
assistance from Australian health clinics is the proximity and accessibility to
health clinics, especially on Saibai, and the high quality health care provided
on the islands. The Saibai health clinic is situated in the centre of the
community, just a short walk from the designated entry point. It is
administered by Queensland Health that is also undertaking design work for a
new primary healthcare centre and staff accommodation on the island.[81]
3.46
For those living in the villages across the border, the distance to a
health clinic in the Torres Strait is generally shorter than that to the
closest one in PNG. Transport and the terrain may also make travel to
Australia's northernmost islands easier, safer and quicker and many would be
familiar with the region and have family connections. Indeed, Mayor Gela
observed that while it may be practical for some villagers to walk to Daru to
access the health facilities:
Some villagers do not have that luxury, so it is quicker,
easier and more convenient for them, rather than walking for 2½ hours to seek
urgent medical attention, to jump in a tinnie. It will only take on 20 minutes before
they hit the shores of Saibai and access our facility.[82]
3.47
Along similar lines, Ms Ellen Shipley, AusAID, noted:
When there is a health clinic available a short distance away
by boat and people need to travel four or more hours or several days to access
the same or similar types of services on the PNG side, they make choices and it
is very difficult to argue with that.[83]
3.48
Mr Kevin Murphy, a researcher focusing on the Torres Strait, noted that
some PNG communities may have a closer connection with the Torres Strait than
other parts of PNG.[84]
Provision of humanitarian assistance
3.49
Another incentive for villagers from the South Fly District to cross the
border into the Torres Strait to obtain medical treatment is their expectation
that they will receive the care they need. This understanding is based on the
fact that Australia continues to provide the necessary health services,
especially for those PNG visitors requiring urgent medical attention.
3.50
As the first point of call in the Torres Strait, PNG nationals who are
ill are treated on their arrival at health clinics on the outer islands. Also,
Queensland Health has established specialist clinics on the outer islands to
treat PNG patients with tuberculosis as part of its cross-border management
strategy.[85]
In addition, the Australian Government is funding 'additional sexual health
clinical staff...at the Thursday Island Hospital including the extra costs,
such as transportation, related to community awareness in the Torres Strait'.[86]
A sexual health program, upgrade of the Saibai health clinic and provision of
staff housing have been allocated $9.2 million of the $13.8 million under the
Health Issues Committee (HIC) package of measures.[87]
3.51
Queensland Health informed the committee that it exercises a
humanitarian duty of care for PNG nationals in need of medical assistance who
present at its clinics.[88]
Thus, when a PNG traditional inhabitant arrives on a Torres Strait Island and
is assessed as having an illness, they are treated by Queensland Health staff
at an island health clinic.[89]
3.52
Ms Nardi spoke of the humanitarian approach taken by health
professionals in the Torres Strait. She suggested that no clinician was 'going
to turn someone away who is bleeding at their door' and asked, 'if people
present at the clinic's door—some people in labour, some of them with acute
illnesses—what do they do with them?'[90]
She explained:
Essentially, if someone presents to our clinics with an acute
illness or an exacerbation of a chronic illness, we will treat them, but we
will not take people who are referred and we try not to continue ongoing
treatment. The idea is to treat that which is before us and then return them or
refer them back to the Papua New Guinea border.[91]
Figure 3.1: PNG villages and proximity to the Torres Strait
(Map courtesy of Dr Garrick Hitchcock)
It is much easier for
some villagers along the south coast of PNG to travel to Saibai or Boigu to
seek medical assistance.
3.53
Australia's level of care extends to medical evacuations to mainland
hospitals and providing treatment that may last many months. Ms Nardi noted
that 'the reality is that we have made a decision that we treat the acute
illness and that does mean that sometimes we have to transport them. That is
just what we have to do'.[92]
This transfer may involve transporting patients from outer islands health
clinics to the Thursday Island hospital or onto the mainland hospitals in
Cairns, Townsville and Brisbane, with the majority transferred to Cairns.[93]
In the 12 months to September 2009, 92 PNG nationals required medical
evacuation, including approximately 15 patients with tuberculosis and
another 15 with obstetric-related conditions.[94]
More recent statistics indicate that these numbers have risen significantly.[95]
Table 3.2: PNG Medivac 1 July 2009 to 31 May 2010
|
Island |
2009–10 |
2008–09 |
|
Patients* |
Escorts |
Patients** |
Escorts |
|
Saibai |
119 |
61 |
58 |
39 |
|
Boigu |
47 |
35 |
16 |
16 |
|
Erub |
3 |
- |
4 |
4 |
|
Iama |
1 |
- |
0 |
0 |
|
Mer |
1 |
1 |
0 |
0 |
|
Ugar |
1 |
- |
0 |
0 |
|
Badu |
- |
- |
2 |
1 |
|
Total |
172 |
97 |
80 |
58 |
*Of
these patients, 23 or 13.4% were from non-Treaty villages
**Of
these patients, 15 or 18.8 % were from non-Treaty villages
3.54
Mr Andrew Heath, DIAC, explained that most evacuations are to Thursday
Island, with some moving to the mainland upon triage assessment at Thursday
Island. He noted that a lot of the medevac cases occur on Saibai and Boigu,
with very few from the other islands.[96]
3.55
The following table provides data on evacuations from the Saibai health
clinic in 2006 and 2007.[97]
Table 3.3: Reasons for evacuation from the Saibai health
clinic in 2006 and 2007
|
Reasons for Evacuations |
2006 |
2007 |
|
Other Problems |
39% |
23% |
|
TB investigation |
18% |
7% |
|
Specialist Review |
12% |
n/a |
|
Wounds/lacerations |
10% |
n/a |
|
Fractures |
10% |
n/a |
|
Surgical Elective Cases |
n/a |
31% |
|
Fractures |
n/a |
9% |
|
Eye problems/Blindness |
n/a |
3% |
3.56
Queensland Health statistics indicated that during 2007–08, PNG patients
spent 3,366 days in Queensland public hospitals.[98]
3.57
Local inhabitants understand the reasons for providing health services to
PNG nationals and support the humanitarian approach.[99]
Mr Kris observed that although communities were still being 'inundated with
people' coming across with medical issues, 'you cannot turn people away from
your doorstep when someone turns up sick'.[100]
Public health
3.58
The Australian Government has agreed to treat PNG patients not only for
humanitarian reasons but also on public health grounds.[101]
Public health concerns are particularly important considering the prevalence of
tuberculosis and the limited to non-existent facilities in PNG for identifying and
treating this disease.[102]
Perceived access to social welfare
3.59
Finally, according to anecdotal evidence, some PNG nationals seek
assistance from Australian health clinics under the misguided belief that they
would be entitled to social welfare benefits. The committee heard accounts of
PNG women choosing to deliver their babies on island health clinics in order to
obtain the baby bonus provided to Australian children and/or to obtain an
Australian citizenship more easily. When questioned about this, Queensland
Health explained that it does not capture data on the reasons for PNG nationals
giving birth in Australia and that 'those issues are for Immigration or others
to determine'.[103]
Conclusion
3.60
Significant numbers of PNG nationals are crossing the border in the
Torres Strait to access Australian health services. There are very strong push
and pull factors driving this trend—poor access to health care services in the
southern part of Western Province compared to the high standard of health care
available in the Torres Strait; the proximity of, and relative ease of
transport to, these services; and Australia's humanitarian and public health
approach to providing medical assistance to PNG nationals in need.
3.61
The following chapters look at the measures that the Australian
Government is taking to reverse the trend of PNG nationals from the South Fly
District crossing the border to access health services in Australia.
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