Medical authorities on Nauru are refusing to send a refugee to Australia for an imminent complex birth, despite the woman’s family and other doctors insisting that her health and that of her baby is being jeopardised.
Medical providers on Nauru have even made a last-minute appeal on the LinkedIn social business network asking for specialists come to the island.
‘Golestan’, not her real name, is a 34-year-old Kurdish-Iraqi woman who suffers from diabetes and has had a difficult pregnancy. She is now 40 weeks pregnant.
Doctors are planning a caesarean because of expected complications.
Golestan’s husband has written to the immigration department at least three times since September asking for her to be transferred.
“I have to save my wife and the baby, this is really important to me,” he said. “She has diabetes, thyroid and kidney problems and has been in pain through all the pregnancy. But [detention centre health providers] IHMS says we can’t help. They do not seem to know anything about my wife’s situation.”
Having previously routinely flown pregnant asylum seeker women to Australia for delivery, it is now Australian government policy that asylum seekers and refugees deliver babies on Nauru.
Aspen Medical, which provides medical services at Nauru Hospital, took the extraordinary step on Thursday to search LinkedIn urgently seeking a neonatologist able to fly out in 24 hours to oversee the baby’s delivery.
“I know this is a long shot but Aspen Medical has been requested to provide a Neonatologist to fly to Nauru tomorrow (6 November), for a week. There will be a baby born by planned caesarean which will require the care and oversight of an experienced neonatologist,” the company wrote in a LinkedIn message to doctors.
Doctors were even asked to nominate a salary.
“I am also curious about what your salary expectations might be for such a role (even if you aren’t actually interested), or if you happen to know of someone else who may be interested.”
World Health Organisation statistics show Nauru has a neonatal mortality rate – number of deaths within 28 days per 1,000 live births – of 21. Australia’s rate is three per 1,000.
Dr Andrew Watkins, a senior Melbourne neonatologist, said he held grave concerns that both the mother and baby’s care was being compromised by the last-minute effort to fly a neonatologist into Nauru. He said the woman should be brought to Australia to deliver the baby.
“They know they are going to deliver a baby in Nauru who will need the services of a neonatologist. What follows from that is that they anticipate this baby will require intensive care and high level support and supervision. Nauru is not a place equipped to be able to provide that level of care, there is a real risk that the baby’s care will be compromised.”
Watkins has written to the chief medical officer of the Australian Border Force explaining his medical concerns about the proposal to fly in a neonatologist “at the last minute”.
Watkins told Guardian Australia that in addition to a neonatologist, management of a sick baby requires competent nursing staff, working and reliable equipment, established protocols, and neonatological oversight, together with a robust and independently audited review of morbidity and mortality, such as is the norm in all Australian neonatal units.
If the baby were to develop severe respiratory distress or other complications, “the backups that exist in Australia, simply are not there,” Watkins said.
“They are trying to do this at the last minute, but they’ve got at least 24 hours. There is time to get this woman to Australia.
“The safest transfer for babies is in utero unless maternal or foetal condition dictates urgent delivery. The fact that this is a planned delivery some days away argues for the safety of this option.”
Watkins said many doctors had refused to accept such roles because they did not want to to lend a “a veneer of legitimacy” to a flawed and potentially dangerous pattern of clinical practice.
The Australian Medical Association said Golestan must be flown to Australia immediately.
AMA president Professor Brian Owler said the immigration minister should stop “playing with people’s lives” by inflexibly applying the government’s hard-line stance on asylum seekers remaining in Nauru.
“It is time for the minister to show some humanity and compassion and fly this desperate woman to Australia for appropriate care,” Owler said.
“The baby will need specialised neonatal care. It is a nonsense to fly the doctor to Nauru. The minister must make the order to fly the woman to Australia now.”
Dr Richard Kidd from Doctors for Refugees said the attempt to recruit a specialist at the last minute could potentially jeopardise the health of mother and baby.
“This has been terrible management,” he said. “This situation has been known about for weeks, even months, and now, in the last hours to now say ‘let’s fly in a neonatologist’.
“They are proposing to fly in a neonatologist without a team and without all the necessary support. This person will have to function as the entire neonatological team, for 24 hours a day, seven days a week, possibly for weeks or months, depending on the health of the baby. It is totally unsustainable and entirely irresponsible.”
Kidd said because of the known and foreseeable complications of this pregnancy, the mother should have been transferred to an Australian tertiary hospital several weeks ago, where neonatal teams, equipment and protocols were already established.
“It is now a very difficult situation. They have condemned her to a very high risk of a bad outcome. They have now made this a very complex and difficult and risky situation.”
Ian Rintoul from the Refugee Action Coalition said deliberate delays by the immigration department had put the lives of baby and mother at risk.
“The risks in a diabetic pregnancy are well established. To delay proper treatment to the point where lives are at risk is medical negligence of the worst kind. Medical best-practice is a distant second to ideologically driven policy agenda of the immigration department.”
Guardian Australia contacted Aspen Medical, who referred all inquiries about its Nauru practices onto the immigration department.
A spokeswoman for the Department of Immigration and Border Protection said Golestan was being assisted by doctors on the island.
“This individual is now fully engaged with primary and specialist health care practitioners. All appropriate support is being provided to this woman.”
A variety of medical providers were contracted to provide services to asylum seekers and refugees on Nauru, the spokeswoman said.
“As the government has previously indicated there was a group of transferee and refugee women on Nauru who were refusing appropriate medical assistance with their pregnancies. However most are now engaging with health service providers