Caroline de Costa, professor at James Cook University School of Medicine (through Crikey.com)
I am sitting in a room with several families and numerous small children on a hot Darwin Saturday morning. Tea, cakes and tropical fruits are being offered. On my knee is a small boy. He is one year old today. But nobody is celebrating.
This boy is spending his birthday in a detention camp. He has been in detention since he was five months old.
Across from me sits his mother, unsmiling, vacant-eyed. His father is in Sydney, on a bridging visa, but his wife and son cannot join him.
Instead they are kept locked up in the hot, crowded environment of the camp, at considerable expense to the taxpayers of Australia.
I am in Darwin on a private visit but am using my many years of experience as a doctor practising obstetrics and women’s health.
The visit has been organised by ChilOut, the group that since 2001 has supported and advocated for the rights of all asylum seekers, particularly those of children.
There are three detention facilities in Darwin in which women and children asylum-seekers are located. These are all referred to as APODs, or Alternative Places of Detention.
As an obstetrician my particular concern has been the care offered during pregnancy and labour to women seeking asylum.
All pregnant women currently are brought to Darwin from Christmas Island at about 34 weeks of pregnancy.
They wait until the birth in the APODs, usually without their husbands and other children, who are left on Christmas Island until closer to the birth.
Mother and baby are transferred back to Christmas Island four weeks after the birth. Antenatal and postnatal care appears to be very limited on Christmas Island, and any woman or baby developing complications needs to be transferred, or re-transferred, to Darwin (or Perth).
Women at high risk
There appear to have been around 40 births to asylum-seeker women in Royal Darwin Hospital in the past few months, with up to 60 women expected to give birth there between now and the end of February.
Many of these women are high risk, from the point of view of their medical or previous obstetric history, or because of factors affecting the current pregnancy.
No additional staff, either midwives or doctors, have yet been employed in RDH to help provide the often complex care these women need.
There is said to be a full-time midwife at Wickham Point APOD to provide onsite care to pregnant women, but I did not meet this person.
There are three IHMS doctors sharing the overall health care of all asylum-seekers, but none have obstetric qualifications.
We were told that there is 24/7 access to a nursing triage service, with a doctor on call, for asylum seekers (male and female, adults and children) in all three camps.
We were also told that there are regular playgroups and ‘mums and bubs’ sessions held in all three camps for pregnant women and new mothers.
Meeting individual asylum-seekers in the visitors’ rooms of all three facilities in the two days following our formal visit, we heard stories quite different from the official accounts.
We observed in many parts of the camps that asylum-seekers, including children and women, are routinely listed, dealt with and addressed by the numbers given to them on arrival by boat in Australia, rather than by their names.
This is highly disrespectful and part of a culture that appears dedicated to de-humanising these people.
As one pregnant woman said to us: ‘You can call me illegal, but don’t call my baby illegal!’
Pregnancy care once a woman reaches RDH is excellent, as would be expected. However, none of the women we spoke to had been seen by a midwife in the detention facilities, neither were they aware of the existence of such a person.
Playgroups and ‘mums and bubs’ likewise were unknown to them.
All had experience of presenting to the clinic with health concerns for themselves or their children and not being seen at all. Postnatal care and assistance with breastfeeding were minimal at best.
I spoke to two women who had recently lost their babies in Darwin: Both stated that prior to their babies’ deaths they had presented to the clinic with complaints (decreased foetal movements, baby stopping breathing) that would be taken seriously in a general medical context anywhere else in Australia.
Both had been turned away from the clinic over several days.
While I have no way of corroborating their stories, and it is impossible to say that the stillbirth and the early infant death that later resulted might have been prevented by earlier intervention, their stories are sufficiently consistent and alarming to warrant immediate efforts to improve current care arrangements for asylum-seeker women.
There is an urgent need for improved antenatal care on Christmas Island, and for more designated midwives and doctors with obstetric qualifications to be employed in Darwin.