23 November 2015
The Australian Medical Students’ Association (AMSA) is proud of its members and the high levels of professionalism they display on social media.
A report today in the Medical Journal of Australia (MJA) suggests that there are ‘damning’ levels of unprofessionalism being exhibited by students, however AMSA President James Lawler said today that this is not the case.
“The MJA study is a timely reminder for students of the need to exercise care in what they post on social media,” Mr Lawler said.
“AMSA has played a leadership role in giving students clear advice on how to manage their engagement with social media and believes the overwhelming majority of students are acting in a professional and responsible way.
“The MJA study clearly has a number of limitations in its methodology.
“While it makes a contribution to the debate over social media, its results need to be interpreted with caution.
“Social media is an important communication tool, and it is with us to stay.
“Issues of unprofessionalism are the same regardless of what communication tool is used. It is this conduct that needs to be addressed, as opposed to demonising social media.
“There are also a range of benefits from social media in medical education, such as the Free Open Access Medical Education movement ( #FOAMed).
“AMSA will continue to work closely with medical students to maximise the benefits of social media in their studies, on the path to a medical career.”
In 2010, AMSA worked with the Australian Medical Association to provide guidelines for the professional use of social media for doctors and medical students. The guide can be found at https://ama.com.au/article/social-media-and-medical-profession
The Australian Medical Students’ Association (AMSA) welcomes the final report of the Review of Medical Internships from the Council of Australian Governments (COAG).
AMSA President, James Lawler, said that although many of the most important aspects of medical training were left out of the review, the recommendations were important to modernise the internship.
“The reviewers have recommended a range of important measures for internships which medical students will welcome with open arms.
“The focus on intern training in a variety of patient care settings, particularly the expansion to other settings like General Practice, is important and should be taken up as a matter of priority by governments.
“Any training that aligns medical graduate outcomes with employer expectations will be better for interns and will be better for patient care.
“The provision of a two-year internship would be accepted, provided the supervision, curriculum, and assessment frameworks outlined in the report are also implemented.
“Developing a better career focus throughout medical education and training will also be a huge bonus if it is matched with the societal need for certain specialties in certain areas.
“Most importantly, a national training survey is vital for governments and employers to have a better understanding of their doctors in training.”
However, Mr. Lawler said integrating the first year of internship with the last year of medical school should be approached very cautiously, particularly as it would require a major overhaul of the curriculum of every medical degree in Australia.
“The onus should be on proponents of an integrated internship model to show that it is clearly superior to the current model, based on a pilot process that considers the whole of the medical education and training pipeline.”
Mr. Lawler also noted that medical students were disappointed the scope of the review left out key issues such as the insufficient numbers of internships for graduates and the concept of a national application system.
“There are over 100 medical graduates who will not be able to find an internship in Australia in 2016 and, as of 2017, up to 10 per cent of domestic graduates from South Australia will miss out.
“This shortfall is primarily due to a lack of places. But the slow, bureaucratic way in which internships are allocated each year between the States also contributes. A national solution is needed to allocate internships.”
The Final Report of the Intern Review can be found here.
READ AND/OR DOWNLOAD THE 2ND 2015 EDITION OF PANACEA HERE.
Continuing on from our successful Not Just a Medical Student Edition, we’d like to keep exploring the theme of balance in medical school. However, rather than from the perspective of medical students who do incredible things outside of medicine, we would like to break this Edition down to Work versus Play, and what it means to medical students.
Find out how your peers from across the country work, play, work harder, play even harder and of course, balance them both. Perhaps, inspiration is even waiting for you somewhere between this edition’s two covers?
We sincerely hope that you have a good read and a laugh or two from this edition of Panacea! If you are interested in writing an article for future Panaceas, or have any questions about AMSA’s publications, feel free to email email@example.com.
READ AND/OR DOWNLOAD THE 2ND 2015 EDITION OF PANACEA HERE.
Nishani Nithianandan | Monash University
About half of the world’s refugees are women.1 Unique challenges for women seeking asylum include:
- Experiences of rape, sexual assault, domestic violence, violence associated with pregnancy, forced marriage, trafficking, female genital mutilation (FGM), bride-burning, honour-based violence, forced abortion or sterilisation.2 Sexual violence and female gender are both known risk factors for post-traumatic stress disorder (PTSD).3,4 Rape may occur prior to, or during flight (eg. within camps). Much has been written about sexual violence as a tactic to subjugate and dehumanise women, and to ‘punish’ rebellious male family members and demoralise communities.5 Intersectionality between gender and race/religion/political beliefs is a key driver behind violence against women of refugee background; for instance, rape of a female political activist or women from ethnic minorities as a form of cultural genocide.
- Unequal gender relations
- Lack of access to education and income
- Increased vulnerability to mental health disorders during pregnancy/postpartum3
- Legislative gender-based discrimination and/or legal systems which fail to protect women’s humans rights5
- Inadequate access to appropriate healthcare in detention, including for high-risk pregnancies
- Experiences of racism, abuse and/or marginalisation in the host country
- Increased vulnerability of, and/or discrimination against, unaccompanied women, women with disabilities, LGBTIQ people, female heads of households, and elderly women1LGBTIQ
What follows is an exploration of a few of the more complex challenges for women seeking asylum.
Criticism has been levelled at the UN Convention’s ‘refugee’ definition, which excludes gender as one of the five grounds of persecution (ie. race, religion, nationality, membership in a particular social group or political opinion) necessary for refugee status.5 Currently, gender-based persecution must be argued under one the other five recognised categories for persecution (ie. women as a ‘particular social group’) and such arguments are not always successful.5.6 In the case of rape for instance, arbitrators may fail to recognise its connection with one of the five Convention grounds, or dismiss it as a ‘common crime’ (ie. commonly affecting women in warzones), or challenge her credibility.5 Whilst some experts argue a correct interpretation of the Convention will properly recognise gender-related persecution, this relies on the decision maker understanding the woman’s experience of persecution within its socio-political context (eg. recognising less conventional forms of political protest such as a woman’s refusal to follow discriminatory laws).7
The issue of private versus state actors poses a further challenge in refugee status determination; for instance, domestic violence, bride-burning and FGM are carried out by private actors (ie. partners, male relatives or other community women in the case of FGM) and yet these crimes will only be counted as ‘persecution’ if state actors are implicated.5 Whilst these crimes are usually socially or legally sanctioned (eg. laws exempting marital rape), it can be difficult to persuade decision makers of state participation in gender-based persecution.5
Perceived credibility of women’s voices presents another challenge for women of refugee background. Gender-based prejudices (eg. that women are less competent, over-emotional, prone to exaggeration) often distort our perceptions of female speakers and lead us to afford female voices less credibility.8 This occurs across society, from workplaces to media portrayals of rape victims. As a group, refugees and asylum seekers are generally viewed with suspicion; their voices and stories are regularly perceived as less trustworthy. Thus women of refugee background are doubly disadvantaged; first as women, and secondly as people fleeing persecution. Examples are rife; in recent years, government ministers have repeatedly accused refugee women attempting suicide or seeking appropriate pregnancy care of ‘blackmail’.9,10 Reports of sexual assault – such as those presented in the independent Moss review – have been recurrently downplayed (‘things happen’).11 Interrogations of refugee women in which they are expected to repeatedly recount precise details of previous sexual violence/trauma, with absolute consistency, play into the narrative of women as less credible sources. (For women in detention, this task is made all the more difficult by exhaustion, uncertainty, unsympathetic interviewers, shame, PTSD symptoms, and/or fear of repercussions.) Furthermore, in cultures where concepts such as ‘sexual harassment’ lack equivalence, women of refugee background may struggle to make sense of, and articulate their experience, which may further undermine perceived credibility.8
Recent media, public and political attention around combating domestic violence is extremely welcome, if overdue. Some are highlighting the hypocrisy of a government committed to tackling domestic violence yet complicit in the violence perpetrated against women in offshore detention. To her credit, Rosie Batty very publicly drew this connection.
Nonetheless, from my vantage point, it seems that the masses pressuring the government to deal swiftly with domestic violence are not all protesting treatment of refugees and asylum seekers, in equal numbers and force. Perhaps my numbers assessment is off; but if not, I can only speculate that the difference in support for the two causes reflects any combination of the following: ignorance of the facts around refugees and asylum seekers; perceived complexity of refugee policy; biased mainstream media; politicians intent on demonising one group of women but not the other; an ‘us and them’ mentality; covert racism; implicit biases regarding refugees’ motivations; geographical distance; or lack of personal vulnerability.
Harnessing the collective outrage of all Australians in support of gender equity – by addressing these factors and framing treatment of refugees as a feminist issue – represents an important strategy to advance refugee policy. Until all Australian women and men recognise that domestic violence and violence against women of refugee background are two sides of the same coin, I can only imagine what the collective voices of millions might sound like.
This article was inspired by a recent panel discussion, ‘Women Who Seek Asylum’, organised by the Wheeler Centre and Road to Refuge.
1UNHCR. Women – Particular challenges and risks [Internet]. Geneva: UNHCR; 2015 [cited 2015 Oct 17]. Available from: http://www.unhcr.org/pages/49c3646c1d9.html
2Asylum Aid. Falling at each hurdle: Credibility assessments in women’s asylum claims [Internet]. United Kingdom: Asylum Aid; 2013 [cited 2015 Oct 17]. Available from: http://www.asylumaid.org.uk/falling-at-each-hurdle-credibility-assessments-in-womens-asylum-claims/
3Collins CH, Zimmerman C, Howard LM. Refugee, asylum seeker, immigrant women and postnatal depression: Rates and risk factors. Arch Women’s Ment Health. 2011;14(1):3-11.
4Gerritsen AA, Bramsen I, Deville W, van Willigen LH, Hovens JE, van der Ploeg HM. Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2006;41(1):18-26.
5Macklin A. Refugee women and the imperative of categories. Human Rights Quarterly. 1995;17(2):213-77.
6Russell SS. Refugees: Risks and Challenges Worldwide [Internet]. Washington D.C: Migration Policy Institute; 2002 Nov 1 [cited 2015 Oct 17]. Available from: http://www.migrationpolicy.org/article/refugees-risks-and-challenges-worldwide/
7Crawley H. Gender-Related Persecution and Women’s Claims to Asylum [Internet]. United Kingdom: International Refugee Rights Initiative; 2014 [cited 2015 Oct 18]. Available from: http://www.refugeelegalaidinformation.org/gender-related-persecution-and-women%E2%80%99s-claims-asylum
8Fricker M. Epistemic injustice: Power and the ethics of knowing: Oxford University Press Oxford; 2007.
9Anderson S, Conifer D. Husband of pregnant asylum seeker pleads for her transfer to Australia; Peter Dutton rules it out. ABC News. [Internet]. 2015 Oct 15. [cited 2015 Oct 17]. Available from: http://www.abc.net.au/news/2015-10-15/peter-dutton-rules-out-transferring-pregnant-asylum-seekers/6856708
10Binnie K, Grimson M. Tony Abbott says asylum seeker mothers attempting self-harm won’t influence Government’s border protection policy. ABC News. [Internet]. 2014 Jul 9. [cited 2015 Oct 17]. Available from: http://www.abc.net.au/news/2014-07-09/mothers-self-harm-wont-influence-coalition-asylum-policy/5583170
11Sedghi S, Donald P, Woodley N. Moss review: Government’s response to Moss review a ‘disgrace’, says Labor. ABC News. [Internet]. 2015 Mar 21. [cited 2015 Oct 17]. Available from: http://www.abc.net.au/news/2015-03-21/moss-review-confirms-forgotten-children-report/6337576
Joshua Druery | University of Sydney
It’s the 22nd of August, 2012 and Leigh Sales, her face set in an intimidating glare, is grilling Opposition Leader Tony Abbott and his ears on ABC’s 7:30 program.
Leigh: “Do you accept that it’s legal to come to Australia to seek asylum by any means – boat, plane – that it is actually legal to seek asylum?”
Tony: “I think that people should come to Australia through the front door, not through the back door. If people want a migration outcome, they should go through the migration channels.”
For years now, “coming through the Back Door” has been used as a euphemism for asylum seekers desperately trying to arrive in Australia. It conjures up images of Afghanis and Iraqis deceiving the West by tearing up passports, of people-smugglers sneaking Rohingyas into Australia under the noses of border patrol, of Syrians pouring into our country like a plague. This rhetoric has been used to justify a bipartisan policy to turn back boats and detain refugees in detention centres. But for the life of me, I could not tell you where the Front Door was. So I found out.
Under international law, the 1951 Refugee Convention was, and is, the central legal document on which we rely when defining the rights of refugees. It also defines exactly what is meant by a refugee:
“[A refugee is defined as an individual who], owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.”
It’s key to distinguish a refugee from a migrant or an asylum seeker. While a migrant may move countries to improve the future prospects for themselves and their families, that person is not fleeing for their life or freedom. An asylum seeker is anyone seeking international protection who has not yet been confirmed as a refugee.
Asylum seekers have certain rights set out in this convention, the most important being that they may not be penalised based on their mode of entry into a country. Whether they have valid visas, identification documents or nothing at all is completely irrelevant under international law. This means that a country that’s a signatory to the Refugee Convention, such as Australia, cannot ever consider asylum seekers “illegal” in the first place; this language is a misnomer that has surfaced out of confusing and incorrect political soundbites. The Refugee Council of Australia has said that:
“It is not a crime to enter Australia without authorisation for the purpose of seeking asylum. Asylum seekers do not break any Australian laws simply by arriving on boats or without authorisation…Australian and international law make these allowances because it is not always safe or even possible for asylum seekers to obtain travel documents or travel through authorised channels.”
Despite this, Australia does have multiple categories of asylum seekers and distinguishes between those arriving in Australia with visas via plane and those arriving without visas via boat. I spoke to a lawyer who has worked with asylum seekers for over 10 years, leading the pro bono refugee practice at his firm. He explained that Australia classifies refugees based on their mode of entry, time of entry and the location in which they arrived and that there are at least a dozen different classifications.
In the eyes of Australian politicians, asylum seekers should ideally be applying for resettlement offshore. This asylum route is through the UNHCR (United Nations High Commissioner for Refugees), a dramatically underfunded UN body that has the daunting task of distinguishing true refugees from would-be migrants. After refugee status is confirmed, these refugees must then live in large camps without the ability to work or build a future while waiting for countries to accept them into resettlement programs. This waiting period can be ten years or more. Considering that there are 19.5 million refugees in the world when compared to the number of places available for resettlement through the UNHCR program (13,750 in Australia, 66,200 in America – and these two countries offer the most places of any other in the world), it is very likely that the majority of people living in the UNHCR camps in the current circumstances will never be resettled. No-one can guarantee that these camps are safe places to live and refugees within them have experienced violence in the past. This is the Front Door.
In light of this, it’s is no wonder then that refugees risk their lives to sail to Australian soil. Under international law any country that is a signatory to the Refugee Convention must offer protection to asylum seekers that travel to their country. Thus far, Australia has given its very best effort to turn away boats before they reach the country’s territorial waters in order to avoid having to process these people at all. I cannot describe this strategy as anything less than cowardly and heinous. What’s worse is that the overwhelming majority (96-100%) of “boat people” are true refugees entitled to asylum but only 20-30% of those travelling by plane can be considered as such.2 It seems quite clear to me that Australian politicians and the media are focusing their efforts on the wrong group of people.
There is, however, another aspect to boat turn-backs. A few years ago the Government had two pathways for refugees: the first the UNHCR Resettlement Program, the second a refugee program composed of any “boat people” or Irregular Maritime Arrivals that arrived throughout the year. Australia would accept their annual cap of refugees from the UNHCR program and also accepted any asylum seekers that arrived by boat for processing and protection visas (which would require their own article). Recently, though, Australian refugee law has merged the two categories so that any Irregular Maritime Arrivals would be “jumping the queue” and taking the place of a refugee that was “going through the Front Door” by waiting for their entire lives in a UNHCR camp. For this reason Australia has refused to process them onshore and has instead sent these arrivals to Manus Island or Nauru. Offshore detention is the “protection” that the Australian Government, as a signatory of the Refugee Convention, is obliged to give these people. Arriving in this manner is the Back Door, a door that by international law is recognised as the only reasonable way of seeking asylum from any particular country.2
Turning back boats and restricting asylum seekers to offshore detention is against the spirit of the Refugee Convention. The actions of the Australian Government and the words we’ve been taught to use when discussing this issue dehumanises the most desperate and vulnerable people on our planet, people that are seeking our help. There are 2628 children that live in Australian detention centres4 despite the recent Forgotten Children’s Report stressing that this detention breaches international laws to which Australia is a signatory. An estimated 50% of asylum seekers on Manus Island and Nauru suffer from “significant depression, stress or anxiety”. There are numerous reports of the rape of refugees within Nauru’s detention centre, refugees on Manus Island have died in riots and from inadequate medical care, and numerous refugees in detention centres both on and offshore have committed suicide. This cannot possibly be described as “protection”.
As a future medical professional, I believe in equality of health, equality of opportunity and the responsibility of health practitioners to give patients the highest level of care possible. This has been our pledge to humankind since the Hippocratic Oath was first taken over two-thousand years ago. The Australian Government has sought to obviate this obligation with the introduction of the Border Force Act, threatening to imprison any doctors, nurses, teachers or other professionals for two years if they release information about Australian detention centres. That includes information about the health of detained refugees even when a person’s life depends on it.
In the coming years doctors will prove to hold a strong place in this discussion. Only a few days before writing this article, doctors from Melbourne’s Royal Children Hospital refused to discharge children back into detention for fear of conditions that would compromise their health and wellbeing. Those that work in health have the privilege of being considered a voice of moral reason within the wider community and I think we all have a moral imperative to give our strength to that voice.
While Prime Ministers have come and gone as through a revolving door, the ideas of the Front Door and the Back Door still remain. Our politicians continue to demonise refugees as an “other”, a threat, fear-mongering for political gain. I hope that this writing might help to dispel some of the myths and legends, rehumanise a stale, semantical debate and demonstrate that Australia makes it very hard for refugees to find any doors into the country at all.
2 http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/ Parliamentary_Library/pubs/rp/rp1415/AsylumFacts
Joshua Druery is a first year medical student at the University of Sydney. He has recently been elected Vice Chair of the University of Sydney’s global health group GlobalHOME for 2016.
We want to thank all of the writers who contributed to the AMSA competition, “Unleash the Writer in You.” At the risk of sounding trite, the pool of talent was deep, and the winners not easy to pick. That said, the Medshop and AMSA panel have poured over the entries and picked our winners.
While their entries did not qualify them for prize-money, the contributions of Cindy Guo, and Kuhan Perumynar, warrant honorable mentions and a round of applause. Keep writing you two. Great work.
Now for the prize money…
Our runner up, and a solid writer by our accounts, Natalie Puchalski will receive a $250 prize for her entry. Great job Natalie and congratulations on your success.
Without further adieu, the top pick, and winner of $500 for his entry in the Unleash the Writer in You writing competition, is… Jeremy Weiss. Congratulations, Jeremy! What a wonderful blog and over-the-top entry. We can’t wait for everyone to read his entry. Keep your eyes on the Medshop Australia Medical Supplies blog to read their entries, which will be filtered in between now and the new year.
Again, congratulations, and thank you to everyone who contributed. Keep writing!
First Published in the Medical Observer by David Rowley
Take AMSA’s Bullying and Harassment Survey here!
AUSTRALIA’S 17,000 medical students have until the end of the month to contribute to the first all-encompassing survey of bullying and harassment in their ranks.
Led by ANU student Anna Szubert and Australian Medical Students’ Association (AMSA) president-elect Elise Buisson, a student at the University of Western Sydney, the AMSA-backed anonymous survey was distributed to potential respondents in mid-August, via local medical student societies, social media and the AMSA website.
AMSA president James Lawler says the intention is to publish the results as an academic paper early next year with Sydney University’s ethics committee having already approved.
GP and the university’s senior lecturer in population medicine, Dr Kimberley Ivory is working as an investigator with the two students. She says that, while it appears women and non-Australians appear to be the most vulnerable, it will be the first time a cohort of Australian students has been surveyed in such detail.
Respondents are asked to nominate which of the nation’s 20 medical schools they attend, their type of training, gender, age, national and ethnic status and sexual orientation.
Over the course of 71 questions, many with sub-questions or Likert scales, the survey asks about most imaginable types of harassment or discrimination experienced first-hand or seen happening to third parties, even allowing for respondents to ‘out’ themselves as being the instigators of the harassment.
Hospitals or off-campus areas where students work are significant harassment grey areas, say both Dr Ivory and Mr Lawler.
19 October 2015
The Australian Medical Students’ Association (AMSA) is concerned by projections that domestic medical graduates from South Australia will be unable to find internships as of 2017.
AMSA is projecting that up to 22 domestic graduates will miss out on internships in 2017, and up to 39 in 2018. In order to become a fully qualified doctor, medical graduates must complete a one-year internship in a tertiary hospital.
AMSA President, James Lawler, said today that medical students who cannot complete an intern year will be unable to practise as doctors, leaving South Australia without much-needed doctors.
“SA Health met with medical students earlier this year and refused to clarify whether or not locally trained domestic graduates would be guaranteed internships as of next year,” Mr Lawler said.
“Medical students have sought a meeting with Jack Snelling but have been unsuccessful.
“Medical students have been concerned by the absence of medical workforce planning from the Transforming Health proposals from the South Australian Government, and these projections justify those concerns.
“It is important to remember medical training does not begin and end with medical school.
“There has been no mention of how Transforming Health plans to train the medical workforce that South Australia needs in the future.
“In order for proper planning for the future of the South Australian Health System, the Government must develop a plan for medical training.
“Failure to do this could see the investment into medical graduates being wasted.
“The South Australian Government should guarantee internships for all domestic South Australian medical graduates, and develop a plan for medical training in the future.”
12 October 2015
The Australian Medical Students Association (AMSA) applauds the efforts the doctors and nurses of the Royal Children’s Hospital in Melbourne.
AMSA President, James Lawler, today said “A doctor’s duty first and foremost is to protect their patients. Medical students fully support any doctor who refuses to send children back to institutionalised child abuse.
“The primary focus of medicine is to preserve and protect the wellbeing of our patients, and politics must not be allowed to interfere with this.
“It is heartening to see the Victorian Health Minister supporting these doctors, and AMSA hopes to see more of our political leaders follow suit.
“Detention is no place for children, with medical students have been very vocal on this front and in speaking out about their opposition to the Border Force Act.
“Whilst the Government, with the support of the Labor Party, has made it illegal for doctors in immigration detention to speak out on behalf of their patients, these doctors are in the unique position of being able to speak freely from Australia’s hospitals.
“We fully support these doctors in their efforts and condemn the provisions in the Border Force Act which could imprison doctors for advocating on behalf of their patients.
“The current model of medical teaching focuses on patient-centred care, focusing on the needs of the patient and prioritising the best possible outcomes for them.
“Medical professionals cannot discharge their patients into harm, as this fundamentally contradicts our professional and ethical values.”
Mr Lawler noted that children in immigration detention suffer extraordinarily high rates of depression, anxiety and self-harm, which cannot be allowed to continue.
“Ultimately, as the next generation of doctors, medical students will inherit the health problems created by Minister Dutton’s political decisions.
“The Prime Minister should take this opportunity to prove that we truly are the country that these refugees dream of – a safe, open and inclusive society, which cannot and will not disregard humanity.”