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Biloela family thanks PCH nurses

As if nurses at Perth Children’s Hospital (PCH) hadn’t been through enough in recent times, in June they came face to face with the harrowing, complex and unmet health, mental health, social and emotional needs of a young child who has spent most of her life behind bars.

Four year-old Tharnicaa Murugappan was flown to Perth from immigration detention on one of Australia’s most remote and isolated territories, Christmas Island (CI). She’d been held there, with her family, behind razor wire, at the Australian Government’s offshore immigration detention facility, kept away from the local CI community, and their home town of Biloela in Queensland, for the past two years. At least PCH nurses were able to help her celebrate her fourth birthday, the only one since she was born that she has spent outside of a detention centre, in hospital. Apparently, unbeknown to the Australian Government’s Department of Home Affairs, and its enforcement agency Border Force, both responsible for the detention of the Tamil asylum-seeker family, which also includes another child, six year-old child Kopica, Tharnicaa was gravely ill in the island prison, more than 2,500 treacherous kilometres away from the nearest tertiary hospital. What most Australians don’t know about CI and its neighbouring coral atoll, the Cocos (Keeling) Islands (CKI), collectively called the Indian Ocean Territories (IOT), is that like the Australian Capital Territory (ACT), and Northern Territory (NT), as well as the renowned Norfolk Island (NI) off the east coast of the country, it does not have state government, and therefore state services are delivered directly or by contract by the Australian Government. This includes health care. The locally managed health authority on CI, and CKI, the Indian Ocean Territories Health Service (IOTHS), staffed mainly by West Australian nurses, is run by the Australian Government Department on Infrastructure, Transport, Regional Development and Communications (DITRDC), and its on-island sub-set IOTA, the Indian Ocean Territories Administration. Despite being based in the most far-flung and treacherous Australian communities on the map, the IOTHS is only equipped to provide primary and short-term acute care, and only has a limited and relatively new partnership arrangement with WA Health. Basically, if you have anything more serious than a common cold, you are medically evacuated off the islands to Darwin or Perth. Maternity services are also not available in the IOT.

Another thing most would not know, not even the locals, is that the IOTHS is not allowed to provide health care to those incarcerated in the CI immigration detention centre, or outside of it for that matter, as their lives and conditions, including their health, are governed and managed by the Australian Government’s Departments of Home Affairs and Border Force, way outside the auspices of even DITRDC, let alone the IOTHS. Imagine what managing peoples’ health in full quarantine facilities, let alone full immigration detention facilities, managed by these monolithic agencies in the IOT, would look like? It’s not pretty. The multi-billion dollar facility on CI is a white elephant, and certainly not an option for COVID quarantine. It’s not viable and it’s not safe, the main reason being it’s at least 2,605 kilometres away from the nearest Australian tertiary health services. When the facility is full, or even fuller than its most recent two adult and two child residents, the Feds bring in medical contractors, for example IHMS (International Health and Medical Services), to deliver health services inside. No wonder it cost more than $90 million to imprison the Tamil family there.

What a mess. Tharnicaa Murugappan recovered from the blood infection she suffered, reported to be caused by untreated pneumonia, after being medically evacuated from CI to PCH in a serious condition.

Her mother Priya accompanied her to Perth, but she was not reunited with her father Nades and older sister Kopika until weeks later when PCH medical staff called for the rest of the family to be released and brought to Perth as part of the sick child’s treatment. Tharnicca was been released from hospital requiring ongoing specialist care, and the family is being held in community detention in Perth, but is reportedly desperate to be allowed to return to Biloela in outback Queensland. Both Tharnicca, and her older sister Kopica, were born in Australia, to two asylum seekers who travelled here, allegedly illegally, by boat. They managed to settle in Biloela, got jobs in a town struggling to find workers, and had a family. But under Australian law the parents are apparently doomed to be deported, causing great trauma for their two Australian-born children, however injunctions have prevented it while the courts determine whether Tharnicaa is eligible for refugee protection. Former High Court chief justice, Sir Gerard Brennan, told the Sydney Morning Herald recently that cruelty was being inflicted upon Tharnicaa to punish her parents. Federal Labor leader Anthony Albanese has said the Australian Government Minister for Home Affairs, formerly Peter Dutton, and now Karen Andrews (both Queenslanders themselves), has the power to grant the family visas and should do so.

Queensland Premier, Annastacia Palaszczuk, and West Australian Premier, Mark McGowan, have both called on the Australian Government to make a decision about the family’s residency. 

What are the IOT?

The Indian Ocean Territories (IOT) of Christmas Island (CI) and Cocos (Keeling) Islands (CKI) are situated 2,605 and 2,936 kilometres, respectively, north-west of Perth, and 490 and 1,270 kilometres, respectively, south-west of Jakarta, Indonesia. The Australian Government has responsibility for the external territories, and through the Department on Infrastructure, Transport, Regional Development and Communications (DITRDC), facilitates the delivery of services normally expected from a state government. State-type services are delivered through Service Delivery Arrangements (SDAs) with the Western Australian (WA) State Government and its agencies, directly by the private sector under contract, or by DITRDC. Additional government services, such as those involving quarantine and customs, and even police (Federal) are the responsibility of the relevant Australian Government agencies.

What is the IOTHS?

The Australian Government, through the Department of Infrastructure, Transport, Regional Development and Communications (DITRDC), funds and operates the Indian Ocean Territories Health Service (IOTHS). A range of services are offered from facilities on Christmas Island and the Cocos (Keeling) Islands, including: • primary healthcare, pathology, radiology, pharmacy and acute in-patient care • public, community and child health programs, and antenatal services • aged care, including home and community care • disability services • accident and emergency care, patient assisted travel and emergency medical evacuation • oral healthcare, social work services • telehealth and access to visiting specialist medical care and allied healthcare. These services are supplemented through a Service Delivery Arrangement with the Western Australian Department of Health, which provides for: • regulatory, policy, governance and specialist medical advice • in-hospital services and care in Western Australia • additional pathology services • mammography screening and assessment services through

BreastScreen WA. The Christmas Island Health Centre comprises of six general ward beds, two of which are currently being used for residential aged care, and two emergency department beds. Services are provided by three General Practitioners and 12 nurses to deliver 24/7 acute and primary care to the community. On the Cocos (Keeling) Islands, services at the Home Island and West Island Clinics are provided by one GP and four nurses. Each of the clinics has one emergency bed and multiple consulting rooms. There is limited capacity for inpatient treatment with overnight care only provided in the event of awaiting medical evacuation to Perth.

What’s the difference?

The IOTHS is the only health system in Australia that is governed, managed and delivered by public servants as part of an Australian Government agency, and that is not a health agency. It is managed from Canberra by the Department of Infrastructure, Transport, Regional Development and Communications (DITRDC), via its on island presence IOTA, the Indian Ocean Territories Administration. In the mix also is the Administrator of the Territories of Christmas Island (CI) and the Cocos (Keeling) Islands (CKI), Mrs Natasha Griggs. She is the most senior Australian Government representative residing in the Indian Ocean Territories (IOT). The Administrator is a statutory appointee of the GovernorGeneral of the Commonwealth of Australia, made on the recommendation of the Government, and whose key function is to represent the Federal Assistant Minister of Regional Development and Territories, Nola Marino (whose electorate is actually Forrest in WA). Mrs Griggs chairs the IOT Regional Development Organisation, Emergency Management Committees, the Interagency Coordination Committee and newly established Health Advisory Groups. Mrs Griggs commenced as Administrator on 5 October 2017, and has been reappointed for a further two years from 5 October 2020.