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Joint Select Committee on the Christmas Island Tragedy
07/06/2011
Incident of 15 December 2010

GRAHAM, Dr Julie, Director of Public Health and Medicine, Indian Ocean Territories Health Service, Indian Ocean Territories Administration, Department of Regional Australia, Regional Development and Local Government

HEATH, Ms Leslie, Acting Manager, Indian Ocean Territories Health Service, Indian Ocean Territories Administration, Department of Regional Australia, Regional Development and Local Government

MOSS, Ms Belinda, Assistant Secretary, Territories West Branch, Department of Regional Australia, Regional Development and Local Government

WILDERMUTH, Ms Catherine, Director, Indian Ocean Territories Administration, Territories West Branch, Department of Regional Australia, Regional Development and Local Government

CHAIR: Welcome. Thank you for appearing twice, Ms Moss, and thank you for your submission. We invite you now to make some opening remarks to the committee, to be followed by some questions.

Ms Moss : Thank you. We gave an opening statement when we appeared in Canberra, so I do not intend to take your time by making a further opening statement at this stage. I noted, in a number of the questions, the interest in counselling support for the community. My colleagues from the hospital can assist you in that. I also seek your leave to table the information document that was distributed widely in the community, and the secretariat has that.

CHAIR: There is no objection to that being tabled, so thank you for that.

Mr KEENAN: Ms Moss, can I ask again about the situation with the boats on the island. From the information we have got, it does have a bit of an element of farce about it. There was a boat that was purchased by the department for the AFP to use specifically on Christmas Island that apparently was not rated for the waters around Christmas Island. That has now been replaced by two boats temporarily. When would you expect that we would have a resolution so that we can actually have some boats, or at least a boat, appropriate for Christmas Island and able to respond here to an incident?

Ms Moss : We gave evidence in Canberra, of course, on the boat issue. As you mentioned, there are two vessels here at the moment that are perfectly capable of response in the current conditions. There is a boat called the Tom Reed, which we have loaned from the Western Australian department of FESA, and there is also an AFP RHIB that was transferred here to the island and that will stay here for as long as required. I think with those two vessels plus the other three vessels that Mr Yates referred to at the hearing in Canberra there is a sufficient response capability at present.

In terms of a longer term capability, it is not an easy issue. We are in very intense negotiations and discussions particularly with the AFP. You are aware that we own both the VMR and the AFP boats but the AFP operates one and the VMR the other, so we are in very focused negotiations with them on how best to move forward in terms of a longer term capability. Mr Yates in Canberra gave evidence that we are moving strongly towards the point of accepting that we need to replace the boats rather than repair the current boats.

Mr KEENAN: You say 'repair'. They have not been damaged, have they?

Ms Moss : Probably I should say refit or refigure the boats according to the issues raised by AMSA when they last surveyed them, in 2010. We had a choice. We could have spent money on bringing those boats up to the standard, according to the deficiencies notified by AMSA. Considering how the boats are about three years old anyway, and the cost of those refits, we are moving to the position that we need to replace the vessels. That is not an easy decision to take. We have to think of the conditions under which they would need to operate here, the survey requirements of AMSA, the types of boats available and, obviously, the wise expenditure of Commonwealth funds.

Mr KEENAN: When would you expect we might get a resolution to that? I assume this applies to Cocos as well. They have had boats arrive at Cocos as well.

Ms Moss : Exactly. It does. The AFP boat on Cocos is exactly the same type of boat that is here, and it is the same boat as the rest of the AFP fleet.

Mr KEENAN: So the boat on Cocos is considered not fit for service there as well.

Ms Moss : I do not believe that is the case. When AMSA surveyed that boat, they did not find it, as far as I understand it, unfit.

Mr KEENAN: But the boat on Cocos is a LeisureCat, like the one that was based here—or that is presumably still here but cannot be used. So it is all right for Cocos but not all right for Christmas?

Ms Moss : That is my understanding, but AFP could give you better clarification of that. That document would have gone to the AFP. Boat replacement would cover, as I understand it, the fleet.

CHAIR: My understanding is that it was initially in survey and was suitable for the island. It subsequently had some buoyancy issues, so it has failed its survey. That is what I understood.

Ms Moss : That is right.

CHAIR: So even though it is the same boat, it is an individual boat problem rather than a fleet problem issue.

Ms Moss : It depends on the conditions under which the boat operates, of course.

CHAIR: We may have to clarify the evidence, because we are doing it from what we have been told of different bits of it.

Senator CROSSIN: My understanding from my recent visit to Cocos is that it comes as a result of the incident off the Torres Strait Islands, where AMSA looked at the quality of the fleet and have upgraded the level of boat that is required right across. It does affect the boat on Cocos Island, as I understand it.

Ms Moss : I may be mistaken.

Mr KEENAN: The reason I am asking is that the problem has been temporarily rectified at Christmas Island because there are two vessels placed here, but it has not been rectified that Cocos where there is still only one Leisure Cat.

Ms Moss : We also have another RHIB from the AFP on Cocos.

Mr KEENAN: That has happened subsequently to 15 December.

Ms Moss : That is right. We brought two AFP RHIBs—one for Christmas and one for Cocos. So there is an operational capability on Cocos, as there is here.

Mr KEENAN: Mr Lacy gave evidence—and I think you were in the room for it, so I am sure you heard—saying that the problem is you cannot get any clarification from AMSA about what might be an appropriate vessel to operate in Christmas Island waters.

Ms Moss : That is right.

Mr KEENAN: He wrote to the department and asked for clarification of that. He has not go a formal response as of yet, he said, but he had got an informal response to say that AMSA were not prepared to do that. Is that correct?

Ms Moss : We are in discussions with AMSA. Part of the difficulty with the boats is around survey issues. That is yet to be resolved with AMSA. They are certainly in negotiations with us as with AFP.

Mr KEENAN: What are you negotiating with AMSA?

Ms Moss : It is a question of when they will certify a boat and how they go about it. There is no certainty of survey until a boat is in the water.

Mr KEENAN: So you will not know whether it is appropriate to operate at Christmas Island until you buy something, and they will come and have a look at it and then they will say, 'No, this is not appropriate,' so the department is exactly back to where it was.

Ms Moss : We would hope that that would not be the case and we will be working hand in hand with AMSA in every step.

Mr KEENAN: But they will not give you something in advance to say, 'Yes, that's the right boat for Christmas Island'?

Ms Moss : Not at this stage.

Mr KEENAN: It just seems ludicrous that you cannot have some arrangement—where they cannot tell you about the boat you are going to purchase, and they can only do it after the fact. It just doesn't seem to make a lot of sense, because isn't that exactly the problem that happened with the Leisure Cats?

Ms Moss : Yes.

Mr KEENAN: All right. Perhaps we should put these questions to AMSA. It just does seem a little unusual in terms of the way it has been handled

Ms Moss : It is a difficult situation.

Mr KEENAN: It is reasonably significant, I would have thought, that you have boats that are appropriate to operate within the environment in which they are placed.

Mr PERRETT: Further to that, the problem is AMSA is the regulator and do not provide advice, I assume. There must be maritime experts who can give the advice that they can sign off on, I assume, at some stage. There must be someone out there that understands.

Ms Moss : This is not my area of expertise. I cannot go into detail on it, I am sorry.

Mr PERRETT: Okay.

CHAIR: The committee may consider formally asking some questions of AMSA. Do you have any further questions, Mr Keenan?

Mr KEENAN: No, I think that clarifies it, although we might get an opportunity to at least write to AMSA to get some clarification.

Senator HANSON-YOUNG: I have some questions for Dr Graham. We heard evidence just before you came up to the table from the medical unit within the detention facility that the whole team really pulled together and worked really well throughout the event. I want to know from you what the ongoing support was for the survivors in terms of engagement with the hospital and your staff there. Could you give us an understanding as to what the process was after that first day.

Dr Graham : I will just mention first off that the team work comes about from the health service having an external emergency plan, which had actually been updated about two months prior to the incident. That incorporated IHMS into our plan to provide increased capacity to deal with any emergency that happened on the island. We are a remote isolated island with limited resources and anyone has the understanding that if there is an emergency on this island we will be overwhelmed fairly quickly. So it was pleasing on that day that the response plan actually came together and the teams worked together to provide the best possible outcome on what was an horrific day.

Regarding ongoing services to the survivors, the Indian Ocean Territories Health Service does not provide ongoing primary health care or day-to-day psychological services. We do have a torture and trauma team, but in this particular instance a team was brought onto the island by IHMS to provide specific counselling to the survivors. So we had no input on an ongoing day-to-day basis with the survivors.

Senator HANSON-YOUNG: On a regular basis, considering that the onsite medical facilities can only do so much, what types of cases would come to the hospital?

Dr Graham : It is similar to any mainland services that require in-patient care. Day-to-day primary health care is managed by IHMS out at either Phosphate Hill or North West Point. Then, if they need any services that require in-patient care, observation, treatment, monitoring or transfer off the island, they come into the hospital.

Senator HANSON-YOUNG: What types of cases would you see?

Dr Graham : As I said, it is similar to anything you might see on the mainland, which ranges from trauma to acute surgical cases to acute medical infectious diseases.

Senator HANSON-YOUNG: What about cases of self harm?

Dr Graham : A lot of the cases of self harm were actually dealt with out at the centre. They have a supportive service out there and they have mental health and medical teams. Obviously if the patient needed hospital care they would be transferred.

Senator HANSON-YOUNG: And things like spinal injuries?

Dr Graham : We provide imaging services—so, cervical, spine and back—within our capabilities. We have limited capabilities within the service to provide emergency services only. We do not have an onsite radiographer or radiologist.

Senator HANSON-YOUNG: If an ambulance were to be called to one of the facilities would the ambulance pick up the client and take them to the hospital.

Dr Graham : Yes. The ambulance is a volunteer service. If they were required to attend the centre they would.

Senator HANSON-YOUNG: In terms of other support services provided through the hospital, I imagine that it is a pretty stressful situation, as we have heard from evidence, even just today, for the people working in these facilities. Have you had people from within the facilities coming to the hospital for the services delivered there, particularly in terms of mental health and psychological issues?

Dr Graham : The hospital provides services to the workers at the detention centre—so, Serco, DIAC and volunteer organisations. On a day-to-day basis we provide that service. We certainly have seen mental health issues coming through the hospital from community members, from staff at the centre and basically the whole range of the community. One of the issues that we highlight in the health service is that events, not just based on the incident of 15 December but on the changes that have occurred in this community over the past two years, have had a significant impact and will continue to have an impact as the detention centre winds down or ramps up, depending on what might happen. So an ongoing mental health service on the island is something that we see as an essential long-term need.

Senator HANSON-YOUNG: How many mental health professionals do you have based at the hospital?

Dr Graham : At the moment, we have four counsellors. Three of those are psychologists and one is a mental health nurse. We have a social worker who is provided through a service delivery agreement with the WA department of—community health? I cannot remember who they are provided by, sorry. Catherine might be able to clarify that one. We also have three very competent trained doctors on the island who I think sometimes get overlooked in the services that are provided to community members. The health service is part of this community and it is respected by the community.

I would like to touch on a point that was brought up previously, about what was put in place for community members after the SIEV221 event. On the day after the event, we sat down and targeted and highlighted people that we thought might have significant needs. This is a multicultural environment, and different multicultural groups deal with their issues in different ways. We have had a particularly traumatic last 12 months on the island, with the death of two community members in dreadful circumstances. We have set up networks to communicate with and support the Islamic community, the Chinese community and the Caucasian community.

I go back to what Mr Perrett—or it might have been Mr Champion, sorry—was saying before about putting resources into supporting family networks and other support groups, and that is something we try to do through the health service as well. One of the things that I think have been maybe only mentioned briefly is the health service's impact on the community and the support that it provides to the community, without the external counsellors coming in.

Senator HANSON-YOUNG: You said that the island has experienced a traumatic 12 months. Going forward, what do you see the health service needs to remain sustainable? Are there gaps that need to be filled? If this is a particularly stressful period for the community, what can we be doing to support them?

Dr Graham : As I mentioned before, one of the things that we are certainly looking at is a long-term mental health component within the health service.

Senator HANSON-YOUNG: What do you mean by 'long-term'—because at the moment it is not?

Dr Graham : The torture and trauma team that is provided is actually funded by DIAC—to provide torture and trauma services to those in immigration detention. We also use those counsellors at times to provide services to the community. We have, as I said, the social worker and also a child psychologist who works at the school who provides one day of adult mental health services. Building up the capacity within the health service with either a permanent psychologist or a mental health nurse—within the actual context of the health service—is something that we would look at for the future.

Senator HANSON-YOUNG: Let me just get this straight. You do have a mental health team based out of the regional health service, but it is paid for and funded by DIAC—

Dr Graham : Yes.

Senator HANSON-YOUNG: primarily for DIAC's operations?

Dr Graham : Yes.

Senator HANSON-YOUNG: Is there a requirement about the amount of time that that team needs to spend within the facilities or dealing with clients or staff? And is that where you try to value-add, based on whatever time is left over?

Dr Graham : We do quarantine time for community. Some of that time is outside of working hours, to fit in with community requirements. It is a flexible service.

Senator HANSON-YOUNG: So you are advocating that the health service itself gets a permanent mental health team, one that is simply part of the overall service and not necessarily linked to the funding from DIAC?

Dr Graham : Yes.

Senator HANSON-YOUNG: Thank you.

CHAIR: I hope you have not already answered this—I was distracted momentarily—but what was the community take-up rate of counselling?

Dr Graham : From the external counsellors who came in, it was minimal, and I think that also needs to be looked at in terms of the timing. This was 15 December and a large proportion of the community leave the island over the Christmas period, and that was when the services were in place. On the uptake for those external counsellors—and each organisation also had counsellors that came on: AFP, Serco, IHMS had their own independent EAP services, but these were counsellors and psychologists brought on for the community—I go back to the fact that quite a few people came through the health service to see the doctors. We referred them on to our counselling team or the school psychologist or the social worker as required. You said there was minimal uptake. I would say that was of the external services provided. There had been quite a bit of uptake within the health service itself and this continues for events like this and the coronial which have stirred up a lot of emotions on the island. We again target the people we know who may not be travelling particularly well or who may be at risk of not travelling particularly well. We have been in contact with quite a few of them in the recent weeks.

CHAIR: This can only be an opinion but are you reasonably satisfied that it is well understood throughout the community that services are available?

Dr Graham : I think so. It was well publicised in the memos that were put out. I go back to the point that we as a health service have quite a good relationship with the community. We had several community members come through us that we then channelled into the psych services on the island. Their first stop was the health service itself.

CHAIR: In your view, was there any more that could have been done?

Dr Graham : In relation to 15 December, the reactions of the community were the normal reactions to a very abnormal situation. People experienced trauma and expressed their response to trauma in varying ways. I think we need to be mindful that the services provided at the time were adequate, but we need to continue to provide services because trauma manifests itself in varying time degrees. Some of the situations that we are dealing with are not related to SIEV221. Memories were brought up about other instances that had occurred previously, so the health service has to play an ongoing role in supporting the mental health of the community.

CHAIR: When you said a lot of people leave the island, what percentage do? Does the whole island pack up and go?

Dr Graham : Almost—it is a very peaceful place over Christmas.

CHAIR: The irony of leaving Christmas Island for Christmas is not lost on me. In many respects it was just a physical non-presence that resulted in a low take-up.

Ms Wildermuth : I would like to add to Dr Graham's answer. We were conscious when we were developing the plans that we put in place that lots of people would be leaving over the Christmas break. In part that was the reason, when we were asking for additional counselling services to be deployed, that we talked to people about timing and continuity—when people might come back, when people were expected back on the island and so on. The second point that the committee may find helpful in its deliberations is that, while there may not have been large absolute numbers for one-on-one counselling, a number of mechanisms were employed by the counselling personnel who were available in addition to providing one-on-one counselling. Those kinds of things included going to community events occurring around the time, having conversations with people in the community to get a sense of how people were travelling, attending a number of meetings that happen reasonably regularly on the island—mothers' groups and so on—and getting in contact with some of the church groups on the island, for example, going along to services in a very low-key way to keep an eye on what was happening. So the point that I would like to make, I guess, is that, while they may not have been involved in one-on-one counselling, they were certainly deployed for the time that they were here doing the kind of work that we had asked them to do. In addition, they were able to provide us with a great deal of advice, as has been referred to earlier, about how we might conduct the memorial service, how we might continue to provide services into the future and so on.

CHAIR: We have canvassed the memorial service fairly extensively, but were you part of the decision-making body that organised it? It was not really the department—

Ms Wildermuth : I was not directly involved as a member of the committee, but I certainly was aware of discussions that were being held, and I did seek on behalf of the committee some advice from a number of counsellors who had been deployed on the island, from our Indian Ocean Territories Health Service and from other people who were on island at the time and who may have been able to provide some useful input.

Mr HUSIC: You said that it was a traumatic 12 months over the course of the 12 or so leading into 15 December. Was it because of the passing of two residents? Did you say that earlier?

Dr Graham : Yes.

Mr HUSIC: Thank you. This is the brochure or flyer that was distributed in all letterboxes—correct?

Dr Graham : Yes.

Mr HUSIC: With the number that is attached at the bottom of the second page, if someone had rung that would they have gone through to a specialist or a counsellor themselves, or is that a generic—

Dr Graham : No, that is a generic hospital number. All they would then ask for is the counselling service.

Mr HUSIC: And then they would just go straight through to them?

Dr Graham : Yes.

Mr HUSIC: Then what would be the process? Would they just set up a time to catch up, or would the psychologists or counsellors be able to go and visit the residents themselves if they needed assistance?

Dr Graham : It depended on what people really felt comfortable with. We had a mixture of people coming up to the health service and being reviewed up there. Sean Devine, our senior counsellor, often went out and met people in their own homes or in a neutral environment where people felt comfortable. So it was a flexible arrangement.

Mr HUSIC: We have had a number of people leave an impression with us that the take-up rate was relatively low. Has any consideration been given to what might have improved the take-up rate, or are you satisfied that people have exercised their own decision and that what has occurred has occurred?

Dr Graham : I think people who needed to use the service at the time used it. Others used other mechanisms on island to provide support, whether it be religious groups, family groups or community groups. As mentioned, people kept an eye out for each other, and that is one of the nice things about a small community: on that day everyone came together. It did not matter what religion or nationality you were; you came together to help. That was seen on the rock face, at Ethel Beach and in the days after, when people were continuing to search for bodies. It was then seen in the recovery of the island in the support that people provided for each other. People knew who was at risk, people knew who might have been suffering and people touched base with them. So I think that, as a community, they pulled together not only for the boat survivors but for the community individuals as well.

Ms Heath : I would just like to add that the brochure was also translated into Chinese and Malay, so we are pretty sure that any member that had a post office box received that brochure.

CHAIR: So that means every postbox got three leaflets?

Ms Heath : Yes.

Senator CROSSIN: Ms Moss, I want to follow up on some of the issues that were raised this morning by Mr Lacy. One goes to the communications. What work is Regional Australia doing in relation to scoping the deficiencies for the black spots on the island and rectifying them?

Ms Moss : This is an issue that is being discussed not only within Regional Australia but with Customs and AFP. It is a whole-of-island, a whole-of-government, in a sense, approach.

Senator CROSSIN: Who is the lead agency? Who drives that discussion and makes sure there are outcomes?

Ms Wildermuth : There are a number of agencies who have an interest in radiocommunications on the island, including Customs and Border Protection, the Navy patrol boats who come through, the Australian Federal Police, Volunteer Marine Rescue, Fire and Emergency Services, St John Ambulance and our own Indian Ocean Territories Health Service. One of the issues is that those different organisations need to be able to communicate both within themselves but also with other agencies, particularly in circumstances of an emergency such as the 15th of December tragedy. We have undertaken a number of things at the recommendation of the emergency management committee and a number of internal reviews by different agencies to try and pull that work together.

Senator CROSSIN: So you are telling me Regional Australia is the lead agency in coordinating this discussion?

Ms Wildermuth : Locally, on the island, we have been pulling that work together. We have—

Senator CROSSIN: This is to sort out the communications problem?

Ms Wildermuth : Yes.

Senator CROSSIN: What is happening in Canberra?

Ms Moss : In Canberra, as you heard, we are in the process of setting up an interdepartmental committee. That has not yet been established; we have all been a bit focused on this committee, coronial and other things.

Senator CROSSIN: You will be the lead agency for that, for driving those discussions?

Ms Moss : We will, yes. That IDC will be chaired by Regional Australia. We intend on that IDC that there will be membership from every agency who is represented on the island, so: AFP; Customs and Border Protection Command; AQIS; DIAC; AMSA; Prime Minister and Cabinet, who are not on-island but obviously have an interest in the issue; the department of environment, through Parks Australia; the Attorney-General's Department; and Defence. Pretty well anyone who wants to be part of it will be part of it. In relation to issues being dealt with here and then again in Canberra, the focus here is basically the operational side of the issues. What we will be looking at in Canberra is a higher strategic level of operation—picking up on whole-of-government issues, securing funding for a number of issues, who will take the lead, making sure everything is linked up at a Canberra side—and we will be informed in that from the discussions that are held here.

Senator CROSSIN: All right. And the aviation fuel supply? It is not the first time this has been a problem.

Ms Moss : No, it is not.

Senator CROSSIN: So what is Regional Australia doing to address a greater storage capacity at the airport?

Ms Moss : Two things. There are three types of fuel, but we are talking aviation fuel. Aviation fuel here is supplied by a company called Air BP. They are a totally independent operator, not under contract to us. We are obviously in close consultation with them at all stages. The fuel arrives by the regular ship. As you are aware, over the period for SIEV221, the port had been closed from earlier in December and was virtually closed almost through to February. So we were in the stage of looking at contingency plans with Defence to actually get fuel in if the boat had not been able to get in finally, which it did.

Senator CROSSIN: Is storage at the airport a problem? If you had a better storage capacity, then you could store more fuel and presumably perhaps the supply would not run as low as it does?

Ms Moss : In relation to the whole fuel situation, you would be aware that in the last budget we received funding for $19.5 million to focus on fuel storage and supply for the three types of fuel used on-island, not just aviation.

Senator CROSSIN: Sorry, I thought that went to the normal fuel supply that residents are relying on.

Ms Moss : No. This is a more holistic approach to fuel. Obviously, fuel consumption was very much increased at that stage by the additional DIAC flights that were coming in, bringing people and taking people out. What this project is going to look at is the inadequate storage capacity and the lack of integration across the three different types of fuel. We are going to be looking at moving or increasing fuel storage facilities, particularly trying to move them away from the tourist precinct down on Flying Fish Cove, and associated synergies and cost efficiencies. That project is just about to begin. So all I can do is highlight that it is underway and it has been funded over three years.

Mr HUSIC: Picking up on that, I noticed in the submission by Customs and BPC, in paragraph 32, that runway issues at Christmas Island might have an impact on sustained surveillance. Has there been anything raised by Customs with the department about modifications to the runway?

Ms Moss : I am not aware of the exact point you are referring to there. These are the sorts of issues that are discussed regularly. The runway is relatively length-limited. It is unusual in the sense that it contains an upward slope at one end as well. It is I think a challenging runway. But, in terms of pavement condition, I understand that it is fine.

CHAIR: As we have no further questions I thank witnesses for attending.

Proceedings suspended from 11:45 to 12:00