Problem cases, red tape and detention fatigue: A GP on Nauru

Paul Hayes

27/03/2018 1:26:39 PM

New South Wales GP Dr Nick Martin tells newsGP about his time as a senior medical officer on Nauru, where he battled as much bureaucracy as he did patient illness in a situation he fears may be endangering lives.

GP Dr Nick Martin found the bureaucracy involved in delivering healthcare to refugees and asylum seekers on Nauru makes it ‘a system designed to fail’.
GP Dr Nick Martin found the bureaucracy involved in delivering healthcare to refugees and asylum seekers on Nauru makes it ‘a system designed to fail’.

Dr Nick Martin worked mostly in clinics at the Republic of Nauru Hospital (the RON), where he treated asylum seekers and refugees. Patients who require medical facilities unavailable on Nauru have to be transferred to either Australia or the Papua New Guinea capital of Port Moresby. However, red tape proved a constant obstacle in the transfer process – even in severe cases.
‘Things like unstable angina, brittle diabetes, consistent kidney stones, lots of musculoskeletal problems,’ Dr Martin told newsGP. ‘[And] I think pretty much every patient at Nauru has a significant mental health case now, after being stuck there for four or five years.
‘The guidelines we worked to on Nauru were based on the Western Australian rural recommendations. So our guidelines for referral and treatment were the same as Australian rural guidelines, but I never saw a case that was referred or treated or seen in the time that we recommended.
‘We might have someone with, let’s say obstructive kidney stones, and that would be something semi-urgent and you’d expect them to get off to have a stent put in. You would put it down as, “this has to happen in a month”, and then 18 months later they are still [on Nauru].
‘That’s the gravity of the delays.’
Dr Martin is currently a GP at the Camden Haven Medical Centre, in Laurieton, New South Wales. Originally from the UK, he spent more than a decade as a surgeon lieutenant commander in the British Royal Navy before coming to Australia in 2012.
Following a one-month placement, Dr Martin embarked upon more permanent rotations as a senior medical officer on Nauru from November 2016 to August 2017. Despite his extensive military background, Dr Martin found he was ill prepared for the complexities and desperation of what awaited him on Nauru.
‘I was on nuclear submarines, was involved in the Second Gulf War, the Afghanistan campaign. I think my military background prepared me for dealing with lots of the little or petty rules and regulations,’ he said. ‘But not in terms of the obstruction, the bureaucracy and, particularly in the children, the level of hopelessness.
‘They used to call it “detention fatigue”, which seems to have settled upon most [refugees and asylum seekers], because they have no hope. They give no hope of going anywhere.
‘I’ve never experienced anything like that before.’
It is estimated that Australia has 1287 people in detention, with 336 people (including 36 children) in detention on Nauru. The overarching issue of Australia’s policy on offshore detention and treatment of asylum seekers and refugees is a complex one. But, from a medical point of view, Dr Martin believes the health of the people on Nauru – as well as doctors’ ability to provide appropriate care – is being compromised by political influences and constant ‘Kafka-esque’ issues or bureaucracy.
‘Pretty much every decision you made to try and recommend someone get evacuated to Australia on medical, clinical grounds, was influenced [politically],’ he said.
‘A firm example would be [pregnant] women requesting terminations, because the Australian [Home Affairs] Minister [Peter Dutton] has said these people are trying to get pregnant just so they can go to Australia, have a termination and then stay in Australia. Or people who are self-harming, they [Australian Border Force] are going, “Oh, they’re only self-harming so they can come to Australia for treatment, and then they’ll stay in Australia”.
‘So, politically, the automatic answer was, “No, they’re not going anywhere”. And that wasn’t made on medical grounds, that was made on political grounds.’
Attempts to provide care to patients on Nauru were also frustrated by issues with available facilities and services.
‘The hospital itself has had millions of Australian dollars put into it, so it looks quite shiny, but it regularly runs out of very, very basic supplies,’ Dr Martin explained. ‘So drugs, paper for the ECG machine, they didn’t have a ventilator that worked, they’d run out of oxygen.
‘One patient was sent away from A and E with a packet of Panadol and no imaging, and he had four unstable lumbar spine fractures and a ruptured pancreas.
‘There’s a refugee patient in a Gold Coast hospital right now who had an epileptic fit [on Nauru]. He was given the wrong drug in the hospital, they didn’t have any diazepam, and is now still in a coma back in Australia.’
As is the case with many international medical practitioners on the island, Dr Martin ultimately finished his time on Nauru struggling to reconcile his desire to help people and an almost overwhelming frustration with being unable to provide the best possible care.
‘After a while it becomes a tipping point where you think, “I’m being put in a ridiculous position”,’ he said. ‘If I walked in [to the RON Hospital] and said, “You’ve got this wrong, we’re taking him back to Australia,” they would either just chuck you in prison or throw you off the island.
‘And you are put in a very difficult position, trying to do the best for these patients. I found it incredibly frustrating.
‘It took a huge toll – it was a very high staff turnover.’
Dr Martin does not pretend to have an answer to the situation regarding asylum seekers and Australia’s offshore detention policies. But, as a doctor, he feels he can discuss the situation and shine a light on an issue on behalf of the vulnerable people who cannot speak for themselves.
‘I don’t have the solutions to policing Australia’s borders or their immigration policy,’ he said. ‘But I do think that if you are going to do this to these people, you have a duty of care, and that’s really where my decision to start speaking out came.’

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Transboi   28/03/2018 10:00:22 AM

Paul Thank You for covering this.

My Dad served in Vietnam (3 Tours) and was Regular Army from 1953-1983, His gone now (65 Cancer - 'Agent Orange') and as cruel as it Sounds I am glad His not here now as this kind of Attiude would have broken His Heart.

He always said one of the Countries Proudest Moments for Him was the way we took in Cambodian and Vietnamese Refugees after the end of the Vietnam War.

In a Word the Current Attiude Stinks.

The Government may say its Actions are in my name - but they most definitely are Not.

Dr Martin Your a Credit to Your Country, to Your Old and New Profession and to Humanity itself.
Thank You for Speaking Out.
It gives us all hope as well as shining a Light on things Some People would prefer to be eternally in Darkness.

Horst Herb   7/06/2018 12:11:30 PM

When I finally accepted Australian citizenship after 16 years of living in this country, I swore to myself I would try all I can to contribute towards all efforts to one day make Australia a country that respects human rights and enshrines unalienable human rights in it's future constitution. I doubt however that I will see it happen in my lifetime. The utter inhumanity, dishonesty, and brutality of the government machine never ceases to surprise.