The Voice of Victor

For a few years my daughter lived in England where she met lots of other young mothers, ordinary white middle class women with orderly lives, healthy babies and toddlers. They all had husbands with jobs, all were native English speakers in an English speaking country. They were all OK. Their babies got croup and cradle cap and they saw competent doctors in a timely way and had access to suitable, safe and effective medicines, and soon their babies were OK again; and they were all OK. 

But one day, one of my daughter’s friends saw the papers, watched the TV news and she stopped being OK. The friend’s name is Ros. And although Ros – a person in London with an ordinary life, who abandoned her day job and roused herself and roused one hundred thousand other ordinary English mothers and fathers and children to demonstrate and campaign for refugees, and this led to David Cameron rousing himself and his government, and this roused Britain to admit many whom they previously would have turned away – this story is not about ordinary Ros.
My daughter left England and returned home to Australia. She and Ros remain in touch. Ros sent a photo that broke my daughter’s heart. She wrote me a letter that included the image below:
 

My daughter’s friend Ros sent her this photo in a letter she came across in a camp on the Greek Island of Thessaloniki. In shrinking lettering near the foot of the letter the writer signed his name, “victor”.

 
My daughter says Victor’s is the despairing voice of one refugee so desperate to be heard he writes on the wall of his tent. He knows no-one hears. She says the world has turned its back. My daughter turns to her writer father with a plea of her own: “Maybe your writing could give Victor a voice. I’m just saying it made me think of you. Do with that what you will.”
I read my daughter’s letter. I read Victor’s letter.
Do with that what you will, she says, then adds, “Going to sleep with a heavy heart.”
Days pass and I don’t do anything.
Every time I switch on my computer, my daughter’s letter asks me, what will I do to make Victor’s voice heard? Something indistinct echoes, something about the unheard voice. It is a voice from a cattle car.
WRITTEN IN PENCIL IN THE SEALED RAILWAY-CAR:

here in this carload 

i am eve 

with abel my son 

if you see my other son 

cain son of man 

tell him I

  

What can I do? What can any of us do? We can try to emulate ordinary Ros. We can write to our local Member of Parliament, write to our faith leaders, speak to our friends. We can do as an ordinary friend of mine does – she organises aid packages. (That friend – a lapsed fundamentalist Christian – writes annually to this Jewish friend, seeking donations of Christmas gifts for Muslim refugees.) We can adopt a Victor – there are so, so many – and write to him. We can send him books. We can remind him he is not alone, not forgotten.

 

What good will these ordinary acts do? In the case of Ros they led to the saving of thousands. In Australia, our ordinary voices were raised enough to encourage our very ordinary leaders to find our captives place of safety in the USA. Our leaders are timid. It is for us to lead them.
(You can find out how to emulate ordinary Ros if you visit http://www.swruk.org/ )

Twelve at a Dinner Table

The year was 1938. In November a coordinated series of pogroms across Germany and Austria saw the burning of synagogues and the shops of Jewish people, and the beatings and murders of Jews on a huge scale. The Night of Broken Glass, Kristallnacht, broke more than glass. It saw the destruction of hope among those German Jews who remained hopeful that this madness would soon pass. In its place a realization, completely new, at odds with the eagerness of the Jew for acceptance: They want to kill us all. If we stay they’ll kill us.   

 

Far away in Australia twelve friends enjoyed a convivial dinner. Long after they’d finished eating the friends sat and talked. A relaxed group,intimate and trusted. One pulled from his pocket a sheet of paper. This arrived in the post today. The stamp reads, ‘Osterreich’ – I think that’s German for Austria. The letter seems to be in German; no-one at work can speak or read German. We don’t know what to make of it. It is addressed to us apparently. That is, we think so. The first line uses our company name. The same on the envelope…

 

 

A hand reached across the table. A second voice spoke: Pass it here. I’ll have ago. I did German at school.

A brow furrowed. A quietness fell, the quiet of satiety and comfort among friends. Hey! This is horrible. Terrible – if it’s true. The German scholar translated. The quiet now took on an earnestness, an intensity, as twelve ordinary Australians grappled with facts that would unseat innocence. The reader’s voice slowed as she rendered the closing lines: Honoured Uncle Borer, Unless we can leave Austria, we will die. They will kill us. Unless you sponsor our admission to your country.

 

 

This story was told at my family dinner table towards the end of a recent Festival meal. At the table sat three generations of Jews, all but one of us born after WWII. We too had sat, sated, content, comfortable. It was the voice of my wife’s sister, Robyn telling the story. She continued: ‘This was a family that was desperate. Jews could still get out – if they had a visa. Australia would accept a certain number of Jews if they had a relative here who would sponsor them – that is if the family would guarantee their upkeep.

 

 

That terrified family in Austria recalled an obscure uncle somewhere in Australia. The only detail they recalled was the name the family had known him by, ‘Uncle Borer.’ Was Borer a first name or a family name? They were uncertain even of that. Where in Australia did Uncle settle? Was he still there? Was he alive? Would he help them?

 

 

Armed only with the ardent desire to live, the family somehow procured Australian telephone directories. They searched for the name Borer. Few were the families in Australia that answered to that name. But the family wrote to every Borer they found, explaining their situation and pleading for Uncle to save them. They never heard from Uncle Borer. But the Manager of a small Australian enterprise listed in the telephone directory under ‘White Ant and Borer Exterminating Company’ received a letter written in the German language, which he brought with him that evening to a dinner party in 1938.

 

 

No-one at that dinner table had relatives in Germany or Austria. None of them had friends there. The twelve absorbed the content of the letter. They contemplated its closing lines, they will kill us…and they heard the words that had reached them like a letter in a drifting bottle – unless you sponsor us.’

 

 

Robyn paused. Eleven of us, all Australian by birth, Jewish by heritage, reflected on our families’ stories of arrival. We knew by name those who sponsored us, we knew the dozens of families that our families had sponsored. The twelfth person among us, mother of Robyn and my wife Annette, was born ninety years ago in Danzig. She too arrived in1938. The matriarch at our table, Nana, our treasure, a brand plucked from the fire, was sponsored, saved. Nineteen Australian citizens, Nana’s descendants, are alive today. (A twentieth is expected).

 

 

Robyn resumed: ‘The manager of the borer company sponsored the family. We know that family, they are friends, but I never heard their story until now. And there’s one more thing – everyone at that dinner table sponsored Jews who needed to escape. Apparently forty people – or was it forty families – were saved by the borers and their ordinary Australian friends. Incidentally one of those twelve was a man named Harold Holt.’

 

 

Harold Holt! I remembered the prime minister from my student days. I remembered him as the conservative who sucked up to the USA in Vietnam. ‘All the way with LBJ’, was his catchcry. Harold Holt giving succour to asylum seekers was not how I imagined him. How old was he, I wondered, when he heard that letter to someone’s Uncle Borer? 
 

 

At our table that night I looked around, mentally counting: twelve, yes we too were twelve. Would we, I wondered – would I – sponsor a family of foreigners as that twelve did? But as matters stand, we twelve Australian adults are all impotent under our present laws to sponsor anyone, not even those who have escaped to Manus or to Nauru.

POSTSCRIPT:

So I looked him up in Wikipedia: “Harold Edward Holt, 5 August 1908 – 17 December 1967), was an Australian politician and the 17th Prime Minister of Australia from 1966 to 1967. He was born in Stanmore, New South Wales and won a scholarship to study law at the University of Melbourne. Holt went into business as a solicitor, during which time he joined the United Australia Party (UAP). In 1935, aged just 27, he was elected for Fawkner. Holt spent 32 years in Parliament, including many years as a senior Cabinet Minister, but was Prime Minister for only 22 months before he disappeared in December 1967 while swimming at Cheviot Beach near Portsea, Victoria, and was presumed drowned.
As Minister for Immigration (1949–1956), Holt was responsible for the relaxation of the White Australia policy.”
So here is one ordinary Aussie, aged thirty, a junior politician who acts and does a private good. Eleven years later, in his public capacity as minister for immigration, he recognizes the humanity of those humans whose skin is not white, transforming for the better a largely monochrome country.

How to Recruit an Ordinary Australian, How to Torment Her, How to Drive her to madness 

Sitting watching Eva Orner’s movie, ‘Chasing Asylum’, I fully expected to be appalled. I anticipated I’d feel the old outrage. I feared I’d see things that would shock me.What took me unprepared was the vision of Australian workers on Manus and Nauru as they disintegrated before the camera. Three in particular found the courage to expose themselves before the slow, careful camera of Eva Orner. Two of the three were young women. The camera never revealed them full face, their names were not mentioned. Like their charges who subsist behind Boat Numbers, these are humans without names. Their voices told us what was happening to the people seeking asylum; but it was their hands that gave them away. Nail-bitten fingers worked continually. A writhing was seen, a slow dance of agony. Voices hesitated, speech fell away as the young women spoke. I watched these young people as they struggled to shed a burden that will never leave them. The third beanspiller was not young. A former prison guard, he was a man in his fifties, a man surely innured by his past experience. He spoke to the camera of what he saw. He recounted carefully and precisely his attempts to bring about change from within the system. How he spoke to superiors, how he complained of wrongdoing, how anonymous threats to ‘shut up’ mounted, until he feared for his life. Finally he fled his island. He returned home and lay low. For some time he did not speak of what he’d seen, what had happened to his detained charges, how he had been threatened and lived alone in fear. Finally he decided he could keep silent no longer: “I was brought up to know right from wrong. I couldn’t live in silence.” The man’s face worked as he spoke. He struggled for composure but grief and pain defeated him as he wept his honest tears.    

Elsewhere in my life I have a colleague, a mental health worker, who has been engaged in the repair of a wounded offshore worker damaged deeply by trying to protect and support detained refugees. Hired by the government, that worker can never safely return to the work that is his vocation, which is to care for vulnerable people. He is now counted among the vulnerable. Innocent casualties, these, like the mates of the former detention worker who told me of two fellow guards who attempted suicide, one successfully.

What are we doing? What have we done.? What price do we demand of our own people? How we disgust ourselves!

When, at some time in the next century, I become leader of this nation I will do some things urgently. Apart from what ever I do to abate our present cruelty, apart from preparing for the Next National Apology, apart from prosecuting the Prime Ministers and their Border Control Ministers for crimes against humanity – apart from all these necessary steps, I will seek out these whistle blowers and offer them honours in the highest echelon of the Order of Australia. But I will not be surprised if they decline any honour offered in the name of a nation that betrayed itself. 
Chasing Asylum is screening now. See it and learn where our taxes are going and what is being done in our name. 

http://www.chasingasylum.com.au/

The Last Refugee

Imagine this. A disaster at sea, a lifeboat adrift, full of survivors, now despairing, now in hope, as land takes form through the mists ahead. A form is seen in the water. The boat comes alongside, the form is human and alive. The human extends an arm in supplication. Weary survivors take the limb and heave. The lifeboat, already heavily laden, tilts, takes water. The heavers persist in their heaving and the boat takes more water. A murmur within the boat swells to a cry: “Let him go!”

But the human is already aboard. The boat rights itself, the shouting subsides to a murmuring. The boat drifts on.

Imagine this: a second story. Australia prospers, confidence surges and trust becomes the settled order of things. Somehow Australia’s peoples lose their fears of difference, neither Sharia nor Tjukurrpa nor Kosher is imposed by any person upon any other person, but all are respected and all thrive. The leaders of the government decide to lead opinion rather than to follow it. They declare, “We who have plenty can take in those who have nothing more their need and their stories. Let us welcome them, let them come in!”

And so it comes to pass. Australia booms, its empty lands are claimed, cultivated and nurtured under the guiding hand of the first inhabitants. Australia feeds its peoples, feeds Asia, and prospers greatly. The seekers for asylum fulfil the promise that every newcomer brings. Australia accepts scores of thousands, who succeed in the new land and become part of the community. The community now takes in hundreds of thousands as History smiles upon the land and even the climate shows clemency.

The seekers for refuge are numberless, the land is vast, its resources seem endless. Eventually the land is filled. The flow of seekers for refuge slows to a trickle. It stops. All now are saved, all are safe. But wait! A boat. Aboard the boat are two persons. They extend supplicating arms. The peoples of Australia, accustomed to rescue, habituated and drenched in its ethos, wish to help. But their land is full. There is no room for newcomers. Australians squeeze up together, they wish to rescue those people who extend those arms. They make room, a little room: just one, one alone can be squeezed in. But there are two humans in the boat.

Imagine this: a third story. A lifeboat full of survivors of shipwreck drifts in an uncertain sea. This boat is full. Its gunwhales barely clear the calm surface. Whenever the seas rise all bail mightily to save the boat that saves them, and the boat remains afloat. The boat drifts on.

A shape is seen ahead in the water. As the boat comes alongside, the shape moves, cries, flings human words of thanks, raises an arm in supplication. All aboard the craft can see, all understand: “This lifeboat is barely afloat. If we take in this human his weight will sink us; every one of us – every human person – is lost.”

So much for my little stories. Readers of this blog are well acquainted with my pain, my outrage, my shame. All that old stuff. My eruptions of moral rage have brought a brief pleasure, a relief not unlike the visceral satisfaction of purging. But these explosions achieve nothing, convince no-one who is not already convinced, influence no-one in government.

A couple of years ago I spoke at an awards ceremony for defenders of human rights. I told my lifeboat stories. I pointed out Australia’s lifeboat is not full. I was grand in my flight of brave words and noble ideals. I carried the audience, which, led by two Federal parliamentarians, rose as one to applaud. Afterwards each of the parliamentarians, one a frontbencher in the government, requested a copy of my speech which they’d put up on their websites. One confided: ”You have said what we would like to say but cannot.”

What to do? What more to do? What can we – we powerless people do – beyond voicing our outrage, our shame, our grief? Firstly, we must continue to raise that human voice, to give human words to the suffering of fellow humans. That voice, those words, these are the marks of our being human. These words, the irreducible minimum:

Written in Pencil in the Sealed Railway-Car

By: Dan Pagis

here in this carload
I am eve
with abel my son
if you see my other son
cain son of man
tell him I

But what more? As my little stories suggest, ultimately we persons of good will – and I mean that to refer to my fellow Australians at large – sooner or later must face a terrible choice. At the end of all our rescuing there will always be one more supplicant, one too many for our resources, for our lifeboat. We will face a choice. This is Sophie’s choice, whereby we will chose one to be saved and send another – a human other – to perdition.

But Australia’s lifeboat is not yet full. So, what more, what wiser, what more potent act can we non-governors do? The answer cannot be simple, but our powers of imagination, of thinking hard and speaking softly, have helped in the past. Thus Petro Georgiou of happier memory, with Jozef Szwarc, softened the adamantine policies of John Howard. The image of a dead child floating in the shallows of Lesvos softened the policies of Tony Abbott.

I know of one small group in a faith congregation that has approached leaders of other faiths in an attempt to think hard together and to speak softly together to those who govern. State governors have spoken for their people, saying, give us the children; let them not return to offshore detention. Dr David Isaacs blew a whistle on his return from offshore that mobilised doctors and nurses at Melbourne’s Royal Children’s Hospital and now at Lady Cilento in Brisbane. The RCH refuses to discharge child patients to places of detention. We must understand that for what it is: the RCH is not some Marxist commune, not a place of sedition. It is rather an emblem in the state of Victoria. It stands for the highest skill and care. When the RCH speaks it carries Victoria. None gainsays its voice or its acts.

So, what to do? Think hard, confer, suggest, bring ideas to government. One idea, hardly original, strikes me as promising: let Australia progressively divert funds, currently used for offshore detention, towards a respectable, respectful supra-national staging and assessment process in south Asia. There we would maintain accessible, supportive consular representation. No-one would need to board a leaky boat, no-one would need to jump a queue, no human person would come to Australia and be called by a SIEV number. Our brothers and sisters would arrive with their own names.

We might save money, we might not. Neither governments nor we the governed see these issues in money terms: governments never count the cost when augmenting our cruelties; and we bleeding hearts never count beans. No, these issues are strangely unmonetised. The people of Australia hanker quietly to regain some self-respect.

Respectful policies will save lives. We might save our souls.

Do you have a better idea? Work on it, tell your minister of religion, your minister of the crown, the playgroup mothers, the neighbours. Governments need to follow. It is up to us to lead. We won’t save everyone, but we can hardly do worse than we do at present.

The Clinician and Detention

Recently Dr David Isaacs, a courageous Australian paediatrician, returned from a working visit to one of Australia’s offshore immigration centres with distressing reports of the suffering and what he considered to be torture of the detained asylum seekers. He called publicly for doctors and nurses to question whether it is ethically permissible for them to accept employment in such settings. Since Dr Isaacs spoke out doctiors and nurses at Melbourne’s Royal Children’s Hospital have refused to discharge asylum seeker p[atients to island detention where they believe the children would be unsafe.
Dr Isaacs risked imprisonment for speaking out and he donated his earnings to asylum seeker relief. He then published an essay in The Journal of Medical Ethics, whose editor – an Australian medical graduate – asked me to respond. This is what I wrote. It is published here with the kind consent of the editor of the Journal of Medical Ethics, British Medical Journal.
ABSTRACT: An examination of ethical issues encountered in the author’s clinical work with detained patients. The author seeks to clarify in which ways, if any, the detained patient might differ from the generality of patients, and hence to identify any distinct ethical duty of the clinician. Also addressed is the broader question: how – if at all – do medical ethics vary from universal ethics? The author reflects on the distinctive duties of a free human towards a detained one. And finally addresses the topical suggestion that a doctor or a nurse should positively refuse to serve in an immigration detention facility on the grounds that to do so would be to condone or facilitate torture.

BY WAY OF INTRODUCTION

The author is a general practitioner of wide experience, having worked in Australian urban, suburban and country practices over greater than four decades; and having spent about eight weeks a year for the past twenty years working in remote clinics. These ‘outback’ postings have been predominantly in Aboriginal communities, while (in 2009) the writer worked for a time In Alice Springs Correctional Centre, and (in 2010) in an Australian Government Immigration Detention Centre offshore.
 
 
DECLARATION OF INTEREST
 
1. I worked in Alice Gaol for lower than average wages; I worked offshore for inflated wages; I banked all proceeds and I paid tax on them.
2. I tutored the editor of this journal in general practice. Our conversations ran particularly to ethics. I became your editor’s friend, his referee, his failed marathon running mentor.
3. As a result of the foregoing I must accept partial responsibility for any ethical errors in your editor’s writing and in his clinical work.
4. I have written and published elsewhere on these themes and continue to do so. They constitute a substantial element in my forthcoming book, ‘Burned Man’ (in press, Hybrid Publishers, for release in August 2016), to be marketed with mercenary intent (and with the opposite expectation).
5. I signed a confidentiality agreement with my employer prior to working in the island Detention Centre. 
6. I worked in Torres Strait (2008) on behalf of the Department of Customs, charged with medical assessment and initial treatment of illegal fisherman captured in Australian waters.
 
 
MEDICAL ETHICS VS ‘UNIVERSAL ETHICS’
 
I read with interest and admiration ‘Are health professionals working in Australia’s immigration detention centres condoning torture?’ The paper addresses a number of important issues explicitly as well as raising equally significant questions implicitly. As I read that valuable paper I found myself wondering whether any distinction actually exists between medical ethics and human ethics generally. An alternative way of formulating my question runs something like this: Why, and in what ways, should a nurse or a doctor – or any clinician – be answerable differently from any other moral agent?
At first blush there would seem to be no difference: in the encounter between any two humans who find themselves respectively in need of help and in a position to help, their inequality mandates a response. That one is sick and the other is skilled in healing is an accident, a detail. This is the bedrock ethic of the Good Samaritan.
However, if among a number of willing passers-by there be one who is a nurse or a doctor, the twin facts of clinical training and of vocation, demand that person in particular step forward and help.
Similarly, the training of the Surf Life Saver selects her to rescue one washed out to sea; and the paramedic is the one who should commence CPR in case of roadside cardiac arrest; and the infectious diseases physician respond to the Ebola outbreak.
 
Common to all these is a degree of risk to the rescuer; the life saver risks drowning, the paramedic risks injury from passing vehicles or hostile lawyers, the physician risks contracting infection and the asylum-seeker’s clinician risks criminal penalties should she reveal official wrongdoing. Traditionally society expects its ‘rescuer class’ to accept those personal risks. In entering our professions we who are clinicians have implicitly accepted – indeed embraced – those risks. So much so that it was with shock that I first heard the suggestion – made in 1969 – that a doctor should not stop to help a road victim, lest the doctor be sued for an adverse outcome. (That advice was given to doctors in litigious America. The advice was ethically wrong, and in many jurisdictions laws have been passed that protect a clinician who responds ethically.)
 
 
ARE DETAINED PATIENTS DIFFERENT?
 
 
My detained refuge-seeking patients resembled all patients in that they were variously unhappy and anxious; their understanding of their condition was inadequate; and they were sometimes unwell, although not in the way they understood themselves to be.
These were patients (although my employers insisted they were ‘clients’); their complaint, their pathos, was the detained condition, to which more familiar clinical entities were superadded.
 
To a man – and the great majority in my care happened to be adult and male – patients in immigration detention suffered from a spiritual malaise, an affliction I have not seen described and which I struggle to categorise. Its features include an inversion of belief such that the detained person replaced trust in fellow humans with mistrust, an expectation of mendacity and malignity of purpose. Thus the clinician, ostensibly present to help, was felt to be the adversary, present only to frustrate and harm the detained one. Our method of harm was supposed to destroy sanity, literally to drive mad the supplicant for our help. The two protagonists became respectively the anti-patient and the anti-doctor. The inversion of belief was pervasive. Hope, the constitutional belief in life and its goodness, were alien, felt to be elements of the fabulous, not congruent with life as it was now known. In a community of almost one thousand believers the mosque was largely unattended.
 
This inversion of the spiritual substrata of life reminded me of Primo Levi’s descriptions of that distinctive moral universe, the Nazi concentration camp, where the SS intentionally destroyed a world of hope, faith, kindness. I do not suspect any such intent on my island. But the outcomes here are as certain as they are unintended. 
 
An unanticipated hazard was experienced by carers, both among the guards and the clinicians. The hazard was moral in nature. Quickly many came to sense wrongness in the system. The wrongs included treating as criminals persons who had broken no law; imprisoning persons who had shown every desperation to be free; humiliating our patients with a dehumanizing system of identification by boat number rather than by name. All who worked in the Centre understood we were functioning parts of an unkind system: while we were to do no harm we were to delimit our own capacity to do good.
Evidence of the moral hazard, the sense of our violence against our own values, emerged in the behavior of the captors. Doctors drank every night, smoked heavily, suffered nightmares. More than one guard attempted suicide, one successfully.
 
In one more than one instance my medical superior refused my referrals for imaging, apparently on the unspoken grounds such would have to take place outside the Detention Centre. In one case, evidence of acute lumbar disc herniation indicated urgent CT scanning. This would require transfer to the mainland. My boss said: ’No. That can’t be done.’ Knowing that it could be done and it should be done, I asked, ‘Why can’t it be done?’
Displeased by my insubordination she stepped forward, stopped half a pace from me and shouted, ‘You can’t ask that question!’
 
For months following my return to the mainland, my reunion with friends and family, my resumption of normal medical work, I experienced nightmares. In those dreams I was a member of a tribunal, sitting in judgement on refugees’ pleas for asylum. In those dreams no voice was heard; supplicants argued mutely; mutely, we judges refused their pleas. The whole was an accusation against my implicated self, against my silent self.
 
 
CRIMINAL DETENTION VS IMMIGRATION DETENTION VS CUSTOMS DETENTION
 
 
The author of ‘Condoning Torture?’ refers to both criminal detention and immigration detention. I have worked in both categories as well as in compulsory detention for Customs. In all three cases detained persons are held inside locked areas behind high fencing in locations beyond view of the public. These arrangements serve to ensure ‘security’, an idea with more than one understanding: ‘security’ has evolved from the safety of the detained person and of the community to security of secrets. Briefly put, locked behind a series of heavy steel doors, detained persons remain invisible to outsiders and hence vulnerable to abuse. These are the settings which some refer to as Black Sites.
 
In the case of my island Detention Centre, the detained resided in their quarters, out of reach and sight of clinicians, who saw and treated them only when they were admitted to the Clinic located in a second secured area. The communicating door between the broader compound and the clinic was manned by the bulkiest of the male guards, charged with selecting and admitting our patients according to acuity of need. In practice these selections were opaque; we clinicians could never know who was excluded from our view and on what basis.
 
Offshore detainees manifest a critical and unique pattern of behaviour which distinguishes them from the great majority of patients of my clinical experience in other settings: they see it in their interest to achieve, demonstrate and maintain the worst health possible. The purpose – or the function – of this ‘poor health’ is to qualify for urgent transfer to ‘the mainland’, a location endowed with a mythic access to liberty in Australia proper. Thus the asylum seeker will exaggerate or fabulate to save himself. The clinician is mistrusted (like all in authority, for all have ‘lied’, and lied maliciously to drive the poor patient mad); in turn the clinician is unable to take symptoms at face value. Trust, the substrate of every decent clinical encounter, is shattered. For the clinician and the imprisoned person have opposite objectives.
 
Quite different are the assumptions in Alice Springs Correction Centre where eighty percent of prisoners are Aboriginal. Here transparency is a cardinal virtue. Prompted by blackfella outrage and whitefella shame, and by the political hazard of failing to care well for imprisoned indigenous people, authorities hasten to identify risk of harm to their charges and to act upon it. Often warders and clinicians over react, such are the anxiety and the dread of misreading need through the clinician’s cultural subliteracy.  
 
 
SHOULD A DOCTOR ACCEPT WORK WITH DETAINED PERSONS OFFSHORE?
 
 
This question arises because of the apprehended possibility that a doctor will participate in or facilitate wrongdoing; and having witnessed harm to patients will be constrained from ‘whistleblowing’ against that wrong. The apprehended risks are real. Under new Australian legislation a clinician who speaks out is open to prosecution and if convicted, to imprisonment for up to two years, for revealing secret information. An additional constraint is the Confidentiality Agreement employees are required to sign as a condition of employment.
 
The author of “Condoning Torture” suggests Australia’s treatment offshore of detained refugees constitutes torture. The writer adduces evidence for that suggestion but stops short of declaring categorically that such treatment is torture. At the same time he acknowledges the clinical needs for care of the refugees. He writes: Australian health professional thus face a major ethical dilemmas. Individual health professionals need to decide whether or not to work in immigration centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.
 
I find the author’s formulation of those questions helpful in pointing a clear ethical path. He authorizes each individual to forge a personal response. This seems to recognize the moral autonomy of the individual practitioner, as well as the individual responsibility of the individual. As the Mishnaic sage Hillel taught: if not me, then who? If not now, then when?
The author breaks the decision into two or three parts:
1. Will I work there? (Do I have the right to do so? Do I have the right to decline?)
2. If I do accept that work, I must do so provisionally, ceasing when I form a judgement that to continue more offends ethically than to desist.
3. In answering the second question I must consider how much my gags prevent me from doing needed good?

The argument allows me to approach the questions as follows: Here, in the offshore ‘facility’ – a black site or a blackish site or at the very least a grey site – we have sick human beings. Our government, their custodians, seeks to employ doctors, nurses, psychologists, mental health nurses, to attend to clinical need. The employer presents the qualified clinical professional with a contract to perform professional duties and to treat the conditions of the workplace confidentially. The government does not stipulate, ‘You must agree to torture your patient’.
 
On the basis of my own experiences, where I was not required to do positive harm but I was constrained from doing some needed good, I could sign the contract and enter upon my employment in good faith and in the assumption of my employer’s good faith. After all, I was employed a medical professional. That profession implies first and foremost a refusal to do no harm. If and when I form the belief my employment required me to do harm, I must refuse and make clear my reasons for doing so, both to my superiors and to my peers. Where possible I must make this clear also to the detained person. Should my employer dismiss me I must make public my employer’s wrongful instruction and my actions and the circumstances of my dismissal. I run a risk in doing this, the risk of incarceration. That is my lifesaver, my paramedic, my infectious disease specialist moment, my moment of familiar medical hazard. A hazard, yes, but in our relatively non-totalitarian system, a hazard without risk of death. Safer far than the ebola risk. Safer than the choices of a psychiatrist in the Soviet Union, safer than those of doctors under the Third Reich. A hazard but not a mortal hazard. 
 
On the other hand if no objectionable command requires me to take a self-sacrificial stand I remain free to work, to watch, to listen and to consider. And upon making my judgement I should speak out. If all is kosher, if detained persons are treated with full human dignity and compassion, then I must cry it from the rooftops. And conversely, if I find my hypothetical centres to be objectionable I must call for their improvement or their closure.
 
Those are equally clear ethical imperatives – not matters of narrow medical judgement but the call of every citizen. In the end the doctor, the nurse, the guard, the journalist, the therapist, the pharmacist, the interpreter, the public servant all answer to an ethic which is universal. Medical ethics represents but one corner of that wide universe.

Among the Lesbians – Ronja and Friends

A young woman from Alice Springs wrote a letter to her father recently. In real life the young woman is a songwriter, singer and filmmaker. Her husband is a human rights lawyer. Recently the couple has been spending some time among the recent arrivals from Syria in Lesvos. You need to have a picture of the writer: imagine an underfed, undersized jockey. Imagine that jockey is entered in a race in which she is obliged to carry a second jockey on her back: Ronja – that’s her name – would be that second jockey. As you will see, Ronja has single-handedly flung English spelling into a bizar new age. She writes:

Dadda,

 

Mine is a strange life right now. I am currently in the Mayer of Lesvos’ office trying to get atms installed in the registration camp Moria (one of the worst places in the world currently). A 5 month baby died there 2 days ago from freezing in the snow, we have up to 5,000 people there most nights sleeping in the snow and rain, not enough food and there are fights and riots daily. The stories of this continue. Rape, gangs, gypsies scamming the etc. it’s a mess.

 

I wake every day and deal with the 70+ volunteers I am responsible for. The admin staff of the foundation all went on holiday 2 weeks ago, so I suddenly became the personal assistant of the woman in charge. Melinda from Starfish Foundation. She was in the Financial Times magazine last year as the number one woman (ahead of Michelle Obama). 

 

A part of this means deciding the vision of the foundation, as well as meeting with the heads of the 100, or so NGO’s (unhcr etc) on the island. I love meeting these people and going to meetings where information is shared. I may never get to work like this again, so am relishing the moments. 

 

She trusts me now and so I work also as a personal sounding board. She wants me to move here and work under her, but we’ll see about that. 

  

    
 I came to clothe and feed people. Instead, I write legal documents, structure how we can implement the best care for refugees and am trying to get funding for special projects: such as information distribution and programs for unaccompanied minors. 

 

I have also been writing music for the foundation for fundraising. I’ll send you the videos when they are posted. That’s been great fun! There are real popstars and so many famous people on this island. Film stars, film makers, musicians and artists. I played my ukulele to Ai Weiwei last weekend and then made a small speech. That was bizar! I think he liked it and he thanked us for our work.

 

Still, I go a bit crazy not having any time to myself and with Shaan. Shaan is in full swing as camp coordinator on behalf of Starfish- you know what he is like.

 

The only reason I can write now is because I am waiting in the Mayer’s office.

 

I am very very interested in what is happening with the unaccompanied minors here in Europe. I met a family of about 50 members from Afghanistan that changed my life 2 weeks ago. Two girls 14 and 10 travelling with a brother who was 17. In the same family a boy 16 travelling mainly with a cousin in this 20s. These three children are legally unaccompanied, so would have been separated, detained and kept in Athens until they each reached the age of 18. They were with family who loved and cared for them, but this was not recognised. They were the most beautiful people and I become very close to the 16yr old boy Mujtaba, who now talks to me every few days from Germany. There is more to this story. 

 

Furthermore, I hear from people who have worked in this area that the children are not properly supervised and are not given proper resources. Most of these children end up running away and getting lost in Europe trying to find their family. 

 

There is also child trafficking happening. We have seen this ourselves. 

 

I want to come back in July and see if I can get into the child compound at Moria camp. One of the good things about meeting all the big wigs is that I have met people who can get me into these areas. The police are in control of the compound, so to be let in is an absolute privilege. If I can get in I want to see if I can come back and run art and music workshops next year. Anyway, we’ll see. It’s all just thought currently, but Melinda knows this is my passion and will help me get permission and money I believe. Right now, my heart and imagination are captured… Also, Shaan will most likely be employed by the foundation in the next few months. AND this crisis is not going anywhere, so neither are our potential roles. Who knows, we may end up living in Greece for a year or two. How surreal. 

 

I better go. The Mayer just arrived. Love you xoxoxoxoxox

A Christmas Story

Every December for a few years now a friend has written to me and to everyone she knows requesting donations so she can purchase gifts at Christmas for people who have found asylum in our country. I send my small donation, very aware of its smallness. Presently my friend sends me – and all her circle of donor people – a photo of the gifts our donations have amassed. I am duly amazed: for in total they are not small.My friend was raised in a home where the ambient Evangelical Christianity weighed heavily. In time and in pain my friend left the family code behind. And so it is that my lapsed Evangelical friend and her many friends – including this unlapsed Jewish friend – send Christmas presents to a bunch of Muslim refuge seekers.

Christmas was never a part of my upbringing. When as a child , inevitably I learned the story of the nativity, I was moved. “No room at the inn” stayed in my mind as the saddest phrase, as a reproach. The inn in which I live is a Four Star establishment called Australia. There is room at this inn, lots of room.

In this state of mind I post the following children’s story. It feels appropriate to the season of goodwill. This is excerpted from a forthcoming book* provisionally titled ‘A Threefold Cord’, to be published on-line in 2016 by Hybrid Publishers. I have read the book and I like it. I commend it to your children: it is ideal for shared reading between an adult and a child aged from eight to twelve years.

This story begins with a five year old girl named Samara mustering her courage and her crumbs of English to tell her story to her Aussie friends, Jennifer, Nystagmus and Snoth:
“This story, my story. Today I say story. I English say.”
Samara spoke eagerly, her face serious and excited at the same time.
Her friends of the Threefold Cord were surprised to hear shy little Samara speaking like this. They listened without interrupting.
Samara stood up and screwed her eyes closed for a moment. She wanted to be brave and she needed to think hard, to search for every English word.
After a moment she started: “Mans with guns come our village. We family very frighten. Soldiers shoot many shootings. Father’s brother run outside house. He praying. Soldiers shoot guns. They angry because I girl, I going school. They think big mistake, they think Father brother is my father. They shoot father brother. He fall down, he not move, he many blood. Soldiers laughing, go away. Father hold his brother, he say Ahmed! Ahmed! He say Ahmed, soldiers shooting wrong man. Must shoot me, not brother.
Ahmed not answer. Father crying, his face on his brother face. Mother crying, my brother crying, Samara crying. Soldiers send bombings onto house. House is breaking. Is very noise, is very frighten.
Then Father hiding us under house. When is dark outside, Father bring donkey. He putting Mother, brother, Samara on donkey. Father walking. We riding, Father walking all night. We come far village, we hiding, we sleeping in day at Aunty house. And in night we riding, walking, we hiding when hear soldiers in night. Always we hearing shootings, bombings, we very quiet, Father giving donkey eating so donkey mouth have food, donkey not speak soldiers.”
Samara paused and blinked. The friends saw drops of water at the corners of Samara’s eyes. The child took a deep breath and spoke again. “I tell about more bad mans. Not gun mans, truck mans. Man say Father, you give money, I take you in truck. Father give man many money, man put family in truck in night. We say goodbye donkey. Brother cry, he loving donkey.
Truck go. Truck stop. Truck man say truck broken, not go now. Father pay money, truck man take money. He say, Truck not work. You walking. Sorry for truck.
We walking, walking, no donkey, no truck.
We come new country, no soldiers shooting. We come big, big water, shiny water like silver. Man say father, You come boat. I taking you family America. You pay money. Is also bad mans. He take all father money, none left now, we get in boat, fast fast, much peoples comes in little boat, such much peoples, boat very crowd. Is dark.
Boat start to move. I am excite and I am too fright. All peoples in boat very fright because big wind and big black cold water. Water come in boat, all peoples scream, cry, cry, scream.
Mother hold Samara and brother, Father hold too, boat is jump, jump, fall, fall, water is in boat, we very fright.
I praying, mother is pray, brother, father – all pray to Allah:please save us, save us please.
Boat stop, water push boat on side, push boat on other side, peoples falling on floor, fall on peoples. Mother, father holding tight children,
Big big water come and boat fall over, all peoples fall out, we all in water, wind is loud. We call Father! Mother! – no-one not hearing. I not hear voice, I looking, is everything black.
I not swimming, we family is not know swim, in our country is desert, is mountain, not is big water.
I look father…”
Samara stopped again and blinked. She blinked again, and a third time. She breathed deeply, opened her mouth, closed it. Finally she produced a small voice: “I look brother, not see.
I look mother, not see.
Father say Samara, you get up on top this wood, you hold tight. Father is lift me, I am hold tight, father head under water. He come up, he not close now, he under water.
I not… I not see him again more. I not see no-ones. I hold wood, I crying, I cold, I not family. Family is gone.
I pray Allah, I praying Allah, you bring back Samara family. If family not live, I not live. Allah, You take Samara paradise. I not family, I not want live.
But all time I holding wood like father saying me.”
The child shivered as if she felt again the cold water. She said: “Soon I say end of Samara Story. Big ship come with big light. I see water, water, empty, all empty. Not peoples, only many water. Man taking me in big ship, coming Australia. Man is good man, Australia man. But Samara alone, I no-one have. I in Christmas Island, I in Australia, Samara sad, sad all days.
Red Cross say they try find family. Maybe in one country, not Australia country.
Then one day you friends come Refugee place.” A small smile as Samara looked from Jennifer to Nystagmus to Snoth. She touched the face of all three.”You tell me many story, you teach me speak English. Samara not alone now.”
 
 
* the author of ‘A Threefold Cord’ is Howard Goldenberg