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Standing Committee on Health, Aged Care and Sport
09/08/2018
Biotoxin related illnesses in Australia

CONNELLAN, Ms Pamela, Private capacity

DWYER, Mrs Annette, Private capacity

EASTMENT, Ms Diana, Private capacity

FOSTER, Ms Janice, Private capacity

STRATTON, Ms Carlene, Private capacity

[13:51]

Evidence was taken via teleconference—

CHAIR: Welcome. This is the third session today that we've done in relation to our inquiry on biotoxin related illness. This morning we've heard from a whole bunch of medical experts, but we also wanted to hear from all of you who have had a more personal experience. I want to start by thanking you for the submissions that you've lodged with the inquiry. I need to formally remind you that this afternoon's proceedings are a formal proceeding of the parliament and the giving a false or misleading evidence is a serious matter and could be in some circumstances regarded as a contempt of parliament. Your evidence this afternoon will be recorded by Hansard and a transcript will be made available to you after the event. We're also being broadcast through the Parliament House website to anyone who wants to listen.

I invite you all to make a short two- or three-minute statement about your own experience and anything that you think that the committee should be aware of. The committee is looking at having a greater understanding of biotoxin related illness and, ultimately, forming recommendations for government about what government can do better. If you have any particular remarks in that respect that would be wonderful.

Ms Stratton : First of all, thank you for allowing me to speak. My injury came about in the workplace, which has caused a number of problems trying to establish causality after the workplace had not carried out OH&S testing on the room a couple of months into my illness. It was specific to a particular room. From that perspective, OH&S legislation is there for a reason and it really needs to be enforced. Given the impact that my injury has had on my whole life—financially, you name it—I'm finding it really hard to have any recompense in any way, and that's developing a proper medical diagnosis. What I've developed is rare and unheard of but we all breathe in the pathogen all day, every day. Our immune systems protect us against it. Sorry, I'm really nervous.

CHAIR: Don't be nervous; we won't bite!

Ms Stratton : I might leave it at that at this point.

CHAIR: Thank you, Carlene. Are you happy to elaborate a little bit more on the circumstances in which you—

Ms Stratton : I am.

CHAIR: Do you want to give us a few words on that?

Ms Stratton : I had been employed to manage the client-side procurement functions for the redevelopment of Star Casino. Not long after I started, I developed respiratory problems and then ongoing bacterial infections, or what we thought were bacterial infections to begin with. I started losing weight. I couldn't tolerate the room I was working in. I developed pneumonia. No amount of antibiotics was helping, so I produced a sample and it tested positive to aspergillus. At that point, my GP phoned the workplace to ask them what was in the room; it needed to be tested. That started two months of obfuscation. I'd gone to the OH&S manager myself and offered up my medical records and still it continued, to the point where I developed pneumonia again.

The only way we realised we could get the room tested was to submit a WorkCover certificate stating that testing had to be done. I was fired two hours later. Since then, I have applied for workers compensation in New South Wales. My claim was accepted for five years and then they used the new legislation to terminate that liability, saying that I couldn't prove causality in the workplace. I've spent three and a half years on this. I've gone through my superannuation, a TPD policy on my superannuation, my assets—I own nothing—and my savings. The only way I could prove causality was for the testing of the room to be done.

CHAIR: And you couldn't do that because they got rid of you?

Ms Stratton : Yes, and they refused to carry out the testing. On top of that, because it is a rare problem to common pathogen doctors, I've seen at least 25 to 30 specialists and none of them have treated someone with aspergillosis. What they do is google it and they come up with ABPA, one of the clinical spectrum, and I don't meet all the criteria for that. Now I host two forms of this pathogen, and now they don't question it anymore. I have not been well in 9½ years.

CHAIR: Carlene, do you feel like—and I'm taking the liberty of calling you all by your first names, so I apologise for doing that.

Ms Stratton : That's fine.

CHAIR: Do you do feel like you're getting better treatment now? You've got a specialist now who better understands your situation.

Ms Stratton : No. Actually, I have a better GP who's prescribing antifungals, antibiotics and steroids. My immune system has changed altogether, and I'm on my fourth course of antibiotics in the last two months. I had an emergency room visit on Monday for an infection around my eye and face. I'm also under a lot of stress—legal, financial. The stress impacts my health, and my health impacts my stress. I feel like I'm in hell, and I've run out of resources.

CHAIR: Are you able to work at all at the moment, or that's just too difficult?

Ms Stratton : No, I haven't been able to work for the last four years, and I'd tried seven return to works in the 4½ years prior because compensation legislation demanded it. My specialist at the time—I can no longer see a private specialist; I don't have the resources—kept saying, 'You can't do this. You're making it worse.' What was I to do?

Illness is one thing, but there are many systems around it that affect you. Try applying for a disability pension. You have to do 18 months return to work. I've done that. I worked with a disability service provider who kept contacting Centrelink to say, 'This woman can't work. She is unwell.' They would not exempt me. I had to keep doing the 18 months of participation. With every medical certificate, when I was really unwell, they would stop the clock. I could never meet the participation.

CHAIR: Thank you for sharing that, Carlene. I know it's very hard to do. Annette, did you want to say a few words?

Mrs Dwyer : Yes. I actually prepared an introduction which I'll go into; however, I have to say that listening to Carlene's story is almost a repeat of my own. I've been suffering from CIRS for over six years. I was also injured by mould exposure in the workplace. I was working as the housekeeping supervisor at Jenolan Caves House. We had extreme mould in a water-damaged accommodation building that was ongoing for at least two years. I'm sure it was longer than that, but I was let go after WorkCover—which I'll go into.

I'm looking at it from several perspectives: obviously, there are the health issues arising from mould exposure and the impact that they have on a person's life; the need for employers to be aware of the health issues—and, in my instance, that was to both the guests and their employees because the guests were exposed as well as the employees; and from a WorkCover perspective, the need for mould-aware doctors to be certified for WorkCover assessments. Like Carlene, people who are injured by mould exposure in the workplace have no opportunity for an informed opinion because there are no CIRS-certified doctors out there that are mould aware and no CIRS-certified immunologists. It's just not possible to get an informed opinion for WorkCover purposes. It's a struggle when you're ill and you're constantly fighting to have rights.

CHAIR: In your submission, you mentioned that some of your work colleagues also had respiratory problems.

Mrs Dwyer : Not respiratory problems. There was another housekeeper who was suffering the same symptoms as me. She had headaches, fatigue, difficulty concentrating and memory loss. I can't recall now whether she had gastro problems, because it was so long ago. My son had constant flu-like symptoms—it turns out he's got his mum's genetics; that was a bit of a hit as well. They were the other two staff that had WorkCover claims accepted, but there were other people that were ill as well. There was a lady in the back office who had vertigo and headaches all the time, but she was never tested for mould. She was still ill at the time I left. We had another housekeeper who said she felt ill every time she went into the mouldy building. We had a young British backpacker who worked for us. After a couple of months of working with us he was hardly ever at work because he had constant migraines and headaches. So there were a lot of people who had symptoms. The three of us got tested for mycotoxins, and we had WorkCover claims accepted. Other people were displaying symptoms but weren't tested.

CHAIR: Thank you for that. We will come back with some further discussion questions after everyone has spoken.

Ms Foster : I've prepared a statement too. I'm not very confident speaking without it. Good afternoon, and thank you for the opportunity to be heard today. My case is most relevant to the fourth term of reference:

Any intersection with other chronic diseases…

I primarily identify as having a condition similar to Lyme disease, but I also have a probable diagnosis of CIRS. I've been debilitatingly ill for the last 17 years and unable to work the last six. Although I have the mould exposure genetic predisposition and MRI results commonly used to diagnose CIRS, someone of my other serology results were unexpected, ruling out a definitive diagnosis. It should be noted, however, that my doctor had concerns about the accuracy of the Australian testing, and I gained objective improvements through treatment. It might seem particularly unlucky that I've ended up with two controversial illnesses, but it's actually quite common.

America's Dr Richard Horowitz, who has treated over 12,000 Lyme disease patients and provided expertise to multiple governments, including our own, observed that the impact of Lyme disease could exacerbate other conditions and vice versa. He has therefore suggested replacing 'Lyme disease' with the term 'multi-systemic infectious disease syndrome'. Its definition includes 'exposure to environmental toxicity'.

CIRS affects brain function, which can have a huge impact on prompt patient diagnosis. Although I had suffered a significant mould exposure incident at home shortly before becoming ill, I forgot about it for over a decade. When I eventually found doctors willing to look at my case holistically, I repeatedly denied prior mould exposure because I simply didn't remember it. When I finally remembered, I felt sure that my current home didn't have any mould. However, a professional inspection found it in places that the average person wouldn't expect, like under a tabletop and also behind framed pictures. Due to memory loss and a lack of education, patients are not always able to give their doctors accurate information about their mould exposure history, even when asked. It's therefore vital that affordable and accurate testing is readily available for medical investigations.

Ms Eastment : Thank you for inviting me to participate. I've also written out my statement so that I don't forget anything. First, I'd like to talk about a water-damaged building I was in. A friend and I purchased a very expensive waterfront villa in a retirement village, but we had no idea of the hidden problem. A stale odour in the kitchen was the only clue. We thought some good cleaning could get rid of the stale odour, but it didn't happen. Only air quality testing revealed the extent of the problem, with the warning that all persons should be excluded from the premises.

It was when we were packing up to leave, after about nine months, and cleaning out cupboards et cetera that we realised the extensive mould growth on all of our possessions. Some of the mould growth was not obvious to the naked eye, but was very obvious when photographed with a zoom lens—for example mould growing on leather chairs and floor rugs.

The second point I wanted to make was, as a result of living in the mould contamination, we developed serious health issues, including chest pain, difficulty breathing, fungal infection, coughing, memory problems and fatigue. However, after much trying, we've been unable to get appropriate medical help. We found there's a lack of understanding and knowledge of the health effects of living in mould. We were unable to get a diagnosis and treatment. One thing that we're concerned about too is that interest in biotoxin related illness seems to be mainly in the realm of alternative and holistic medicine. We really feel that it needs to be taken up by mainstream medicine, with medical practitioners specialising in this area.

CHAIR: Thank you, Diana. And, last but not least, Pamela.

Ms Connellan : I have written out a little bit of information. Thank you for the opportunity. As everyone has said, one of the hardest things about having CIRS is that you can't go down to your local doctor and talk about it, because they don't know anything about it. I lived in a mouldy house in Sydney, on the North Shore, for 11 years. I'm a very health-conscious person. I knew it had mould, but I had no idea that mould was that bad for your health. After I'd been there for 11 years, I got a tick bite and, because the mould was always there in the background, I felt I was much more likely to get Lyme disease from that tick bite, which I did, and that was 4½ years ago. I do feel, if there had been more information about CIRS out in the environment, I would have known, for a start, to avoid living in a mouldy place, and there would have been far less chance of getting Lyme.

In the last 4½ years I've spent nearly $200,000 on my health, trying to get better. I've had to see overseas doctors. I've had to go overseas, to Germany, for treatment for the Lyme. But then I come back and I know there's still something wrong. So I've still got CIRS, but it's very difficult to find out and to get help with that. If we just had more information, if generally doctors knew that living anywhere near mould or working near mould is going to suppress your immune system, and that's going to make you much more susceptible to any other illness that might come along, then—I'm health-conscious person—I would have done everything that I could have to avoid that, and for my children. I've got a younger son, and I think he probably has it in the background as well, although he's not really showing that many symptoms now. What people can tend to do is that they have it in the background, and you don't really know until their body gets under crisis.

I've actually moved four times. I've had no-one here in Australia to help me move properly, so that I get out of the mould. Every time I've moved, I've taken something with me and it's brought the mould back into the house. I'm about to move again. Hopefully I'm doing it right. All the help that I've gotten for this has mostly been from overseas. I've had to Skype doctors in California, and they have told me what to do. I have finally, only over the last six months, found Dr Sandeep Gupta and Dr Rashmi Cabena, who are both based in Maroochydore. They have been very helpful, but they can't treat the whole of Australia.

If you actually look at Australia's climate, we are really susceptible to mould. We live in quite a humid environment. It's quite hot. A lot of the conditions in quite a few areas of Australia mean that houses are very prone to getting mould in them. One of the things I'm very passionate about—as well as a lot more information out there in the community, which would be so much more helpful, and many more doctors trained, which would be so much more helpful—is that I think we need to look at our building codes for our houses and units and workplaces in Australia, because, with this climate that we have, if we don't take that into consideration we're going to have so many more people ill with this disease.

We really do need to spend more time on this. I've virtually lost the last 4½ years of my life researching and trying to find out how to get better. I really don't want that to happen to so many other people, but I hear about it happening to other people. I think there are a lot of people out there that aren't even diagnosed. They don't even know they've got mould. They think they've got chronic fatigue or something else. As you've heard from the other people that have talked, if we could just get some doctors trained so that they know how to diagnose us, how to help us with the symptoms. The testing costs a thousand dollars for one test, and none of it is claimable. The Medicare system isn't really helping us at all. I feel like, in 4½ years, I haven't really been able to utilise Australia's Medicare system at all. I've had to utilise overseas medical systems, and I've had to pay a lot to do that. There are people out there who can't afford to do that. I'm in a very, very lucky situation to be able to do that, and I just don't want other people who are sick and don't know what they've got to be left out, so I'm thankful that you are doing this inquiry into CIRS and biotoxin illness.

CHAIR: Thank you for that, Pamela. Obviously we're in a circumstance where Australian medical practitioners seem to know so little. I think all five of you talked about how you've had to do a lot of the research yourselves. Have you found that there is a support network amongst those with the condition or the syndrome so you can talk to each other, share experiences and that type of thing?

Ms Stratton : No, not in Australia. There's an aspergillosis support group online based mainly in the UK and the US, and I was a part of that for a while.

Ms Foster : There is actually a Facebook group here in Australia. I personally don't use it—the only reason being that, as everyone else has said, there are so many things associated with this illness. It takes a lot of your life away from you. It causes a lot of emotional impacts as well as financial and social impacts—anything you can think of. I personally have just gotten to the point where I can't cope with hearing that other people are suffering the same way I am. I feel bad enough that I'm going through it. When I hear about everyone else going through it and hear that there are instances of people going through things worse than what I am, I feel obligated to help them because I'm one of the few people who understands, and then I end up getting sicker because I'm not concentrating on my own health the way I should. So I'm not making use of the support groups available in Australia.

Ms Connellan : I'm a little bit the same—I haven't really used them. There are quite a lot of support groups for Lyme disease, and a lot of them talk about mould, but they're not specifically for mould. I find the same thing—that you run out of time because you've got so many appointments. You've got to do testing and you've got to buy supplements. You're so busy all the time—I've moved four times in four years—so your time is very precious. You lose a lot of time.

Ms Eastment : I'm not aware of any support group. I just know of people in my social network who have been through similar experiences, so we support each other.

Mrs Dwyer : I only recently found out about the Toxic Mould Support Australia Facebook page because I'm not a Facebook user. I think I got the link from AESSRA, which is the Allergy and Environmental Sensitivity Support and Research Association, and I found that that's been informative. I found out about this biotoxin inquiry through there, so that was a real plus to start with. But, yes, I find it very draining sitting at the computer. I find that that actually makes my fatigue worse. So I try to check in every now and again to see what people have to say and if there's anything informative there, but it's not something that I can do a lot because, as I said, I just find it too draining.

CHAIR: Do any of you feel like you've now finally found a GP or a specialist who is giving you the right advice? Second to that, do any of you feel that you're now on a pathway to recovery, if I can put it that way?

Ms Stratton : I have a GP who will prescribe me the treatment that I ask for now. There is no cure for aspergillosis. Most of my medical care is managing symptoms and trying to reduce the amount of bacterial infections that I develop. I'm now under the care of immunology at Princess Alexandra Hospital in Brisbane. I see them once every three months, so it is not very effective at this stage.

Ms Foster : If I could go back to the previous question, I've just logged onto Facebook. There is a group called Toxic Mould Support Australia. It currently has 3,314 members. Just to go to the most recent question, I have seen one of the very few doctors that treats CIRS. As I mentioned earlier, I've had difficulty getting a full diagnosis because of issues with the serology. My doctor has attempted to ensure that Australian pathologies are getting results consistent with what has been produced in America for years. It hasn't happened as yet. I have recovered to some extent, but I'm still unwell. My doctor says I don't have classic CIRS but it's pretty close, and that overall it he considers me a very complex case with a mixed bag of problems. That's where I am at the moment. Am I on the road to recovery? I don't have clear trajectory, but I have improved.

Ms Eastment : We haven't yet found anyone who really understands the issues we're facing or knows what to do about them. No, I don't feel we are on the road to recovery yet.

Ms Connellan : I have been happy. I've been talking to Dr Sandeep Gupta and Dr Rashmi Cabena. They are here in Australia. It's been good to talk to doctors who understand what I'm going through. But testing is still very difficult. Also, I'm often skyping them or calling them. They're in Maroochydore. Sometimes they can come down to Sydney and do a clinic. I do feel I am on the path to getting better, because I've gradually got the mould out of my environment so I'm not being constantly reinfected. But that does take quite a while if it's in the home, because basically you have to get rid of a lot of your possessions, probably 50 to 60 per cent of your possessions, because they have the mould in them. That's what I've had to do. I think that I am getting better, but there is no fast cure. It's not like I'm going to be cured in six months. I might be well on the way with one or two years of treatment. That's only because I've just now not been constantly reinfected with mould. It's very subtle when it's in your home environment.

CHAIR: We had Dr Gupta down here this morning, and he was very helpful to the inquiry.

Ms Connellan : He's written a whole course, and I've done that course. He has an online course about CIRS that he urges his patients to do. You can go through each of the sections and learn a lot more about what's happening, which is really helpful.

Mrs WICKS: Thank you for sharing your stories, ladies. I know that's every single one of you has probably only told us the tip of the iceberg, from what I understand. I know it is also a very difficult thing to talk about. I want to go back to some comments that were made by Carlene Stratton and Annette Dwyer. Obviously you've had your own journey in trying to determine a diagnosis and cause. You've also indicated some interactions with workers compensation or WorkCover. What do you think are the main impediments to be able to be adequately protected by such schemes as WorkCover or workers compensation? What are some of the impediments to being protected from workplace exposure to water damage to buildings?

Ms Stratton : If someone reports respiratory symptoms in a particular area and your GP requests testing of the air quality, it really needs to happen. I don't know if there was a point at which I could have left and stopped what's happened, or whether, once my immune system is compromised, that has been it. I will never know the answer to that question. But as far as the ongoing workers compensation problems, without that definitive test to say yes, it was in that room, after five years of my claim they found, with the change in legislation, a get-out clause. They can just say, 'No, it couldn't happen there.' I have to prove that it did, and I can't because that mechanism was removed from me.

Mrs Dwyer : In my experience, I had the WorkCover claim accepted. I was asked to take some time off work to try to get my health in order. Then I lost my job because they never found me suitable duties to go back to. The problem I had with WorkCover was trying to find a doctor who was actually SIRAcertified to do a whole person impairment assessment. It's primarily an immunological condition, and there are no SIRAcertified immunologists. So the insurer sent me to see an immunologist in 2015. I've only just finally been given that report. He concluded that my illness was caused by mould exposure in the workplace, but the insurer refused to accept his opinion because he is not SIRAcertified. We've got a problem that people who are injured in the workplace need to have a doctor who is actually SIRAcertified to do an assessment, and we don't have any mould-aware doctors to do that. I had a solicitor that tried for five years to find a doctor who was SIRAcertified and would do an assessment. They ended up telling me in March this year that they could no longer act on my behalf because they couldn't come up with anybody. So it makes it difficult when you have an illness; the illness is accepted by a specialist; but you can't go anywhere with it with WorkCover because the doctor doesn't have that certification that says, 'Yes, I can assess whole person impairment.'

Mrs WICKS: Two questions, firstly to Carlene and Pamela. We heard a lot in the earlier roundtables about the need for clinical guidelines for doctors and the need for guidelines in relation to buildings, and particularly the diagnosis of whether there is water damage present and to what degree, and a consistent approach to that. Do you think that would have helped you in your quest to have this recognised as being from the workplace?

Ms Stratton : They wouldn't comply with work health and safety legislation. I don't know what else could have happened. Aspergillus doesn't particularly have a smell. It may have come from contaminated air conditioning. It can live on any substrate. They'd replaced the carpet a year and a half before. I don't know why, as I wasn't there. The room was adjacent to a kitchen, which would be a prime area for a leak behind the wall. I don't think it would have made a difference with this employer. I tried a temp role with the Garvan Institute of Medical Research. They had a fungal problem in their tissue culture laboratories. A number of the scientists were developing symptoms. They did testing straightaway, and then introduced infrared coils into their air conditioning system. That's the difference between one employer and another.

Mrs WICKS: Thank you. Annette?

Mrs Dwyer : I'm sorry. What was the question again?

Mrs WICKS: We heard consistently about the lack of guidelines for doctors in this to enable them to diagnose more effectively, and we also heard about the lack of guidelines or regulation in relation to mould in buildings and mould remediation. My question is: if there were such guidelines and such regulation, do you think that would have helped you, perhaps, a little earlier?

Mrs Dwyer : Perhaps, but I have my doubts. I was trying to make the management aware of the mould issue for two years, and it was just shrugged off constantly. Perhaps, if there were a guideline and they knew that they could have problems and people becoming sick from it, it might have made a difference. It's really hard to tell. My experience was just that it wasn't taken seriously. Even after there were staff who had health issues that were accepted as being caused by the mould, they still didn't take it seriously. So I don't know. I think it needs to be something that will really hit home to make some people open their eyes.

Mrs WICKS: Thank you.

Ms Connellan : I just feel that mould illness is one of those ones that aren't taken seriously. I have friends and colleagues who I tell that I've got it, and they still don't really believe me, so it's going to be hard to get people in the workplace to believe you sometimes. I just think it's because we don't have enough information out there in general. People really don't have any idea how harmful mould can be. You don't even have to be able to see it. There are different types of mould, and some types of mould are microscopic. It's very hard to see. So it's one of those things that we need to educate everyone on: doctors, employers and the general public. It's the same as a lot of those. It's fairly intangible. There needs to be more information out there, because people still sort of say: 'Oh, sure, you've got a bit of a mould problem. Well, you'll get over that.' They don't realise that this is a really serious problem and can lead to such a serious illness. You almost have to sit people down and say, 'Hang on, I am really sick,' and they don't believe you. So I just feel for someone who's experiencing it in their workplace. I think that would be a very difficult situation.

Mrs WICKS: Thank you. I think we've nearly run out of time. I just wanted to ask one final question of each of you very briefly if I may. I've heard or read a number of stories, and everybody seems to have some underlying common themes and some different experiences as well, but for many people it seems to be quite a debilitating experience. I guess this is to each of you: what is the biggest cost or the biggest challenge that you're dealing with compared to when you were well, before this happened?

Ms Stratton : Financial cost. I earned a six-figure salary, and now I have been living off an income that doesn't even cover basic living costs, and I'm not even including rent in this. I'm unable to seek proper specialist medical treatment, because I can't financially. It is crippling. For example, one medication I take is $700 for a bottle. A bottle lasts five days. PBS subsidises that $50,100 a year. I am a high cost. I don't see why PBS should be funding that sort of thing when it was a work related injury.

Mrs WICKS: Thank you.

Mrs Dwyer : I'm also in the situation where I haven't been able to work. Once WorkCover payments ceased at the end of last year, our household lost a total income. That's difficult because we've been a two-income family. I was working at Jenolan Caves for 18 years. It's difficult to go back to being a one-income family. Of course, there are the medical expenses on top of that, so it's reduced income and extra medical expenses.

Ms Connellan : I would say it's definitely financial, but the problem is that the financial moves into the stressful, which does impact your health and makes it harder to get better. I've had to work much less. I've been able to work throughout this because I've been very lucky. I got onto the Lyme very quickly, and then I had to handle the mould. Basically everything costs—everywhere you turn, every test you have to do, every doctor you have to see. Even my diet is quite expensive. I have to eat certain things; I can't eat other things. There's a very specific sort of food that I have to eat. My whole lifestyle is very, very expensive. I can't work very hard and I can't push myself too hard. That leads to stress and it leads to build-up of debt, and then you're constantly stressed out about money. Nothing is claimable. As I said before, I don't seem to be able to claim anything because a lot of the treatments that I'm doing are natural treatments, so they're all not classified as something that I can claim. Therefore I'm not really getting any help from the medical system here. That leads to more and more stress, which is just not a good cycle.

Ms Eastment : The problem is not so much financial; just being able to get help to alleviate symptoms and to feel better would be great.

CHAIR: Thank you. That concludes the time that we have available for this afternoon. Can I just thank all five of you for agreeing to participate and make a submission. We can hear from an army of medical experts, but, to be honest, when you actually hear from people that are at the coalface, so to speak, it makes it so much more real in many ways. All of you have been very courageous in speaking to us today. I hope that through this inquiry we can start to address what's obviously been a very hidden syndrome. As all of you have said, I think, the starting point has got to be to try to make sure that we have greater medical expertise here so that you're not bouncing between doctors and specialists and getting no relief at all. So thank you all for your time. It's been very valuable to us to have you involved in the inquiry.

Committee adjourned at 14 : 38