Drug resistant #tuberculosis confronting #Australia’s border security

With the emergence of the concept of a Nation State the world moved beyond tribe and clan, entering a new era in which the notion of the state rested on largely imagined and unsustainable historical constructions. Now in Europe we are witnessing the gradual end to such naive notions but in island nations such as Australia the illusion not only persists but can assume a large and unhealthy position within our domestic political agenda. Developing a sense of realism and effective border management, freed from the simplistic notions of border protection, is essential if both the political and actual health of our nation is to be sustained.

Developing the correct policy mix and response to developments in our region, rests on a clear understanding of just how Australia fits into it’s biogeographic and cultural context. None of this is simple, we’re bound to make mistakes. This post is about one such mistake, one that can still be easily avoided and one that can still be addressed with one small tweaking of our policy response.

The enthnogeographic realities of the border region
Back in August 2010 I wrote more extensively about the general issue of our borders in a post entitled Indonesia and Australia: perceptions of border security from the land that’s girt by sea. To anyone who read that post, or has reflected on the matter of Australia’s physical margins it will be clear that both biophysically and socio-culturally there is constant interaction between Australia and what surrounds us. Traditional fishers from the Indonesian archipelago continue to visit Australian waters while our border with Papua New Guinea (PNG) is a culturally arbitrary one.

A treaty, commonly known as The Torres Strait Treaty between Australia and PNG describes both a seabed and fisheries boundary between the two states.  It is a response to the porosity and enthnogeographic realities of the border region. The Australian Department of Foreign Affairs and Trade (DFAT) has a posted a most comprehensive website addressing this issue.

DFAT has published a map outlining the two boundaries.

Seabed and fisheries jurisdictions and the protected zone

This is no ordinary border, whatever the understanding most Australians might have this is a border that concedes in a most undeniable manner, the transitional nature of the border between Australia and PNG.  The border region includes a Protected Zone.  This is an area of the Torres Strait recognised by Australia and PNG as having special characteristics.

The Protected Zone is a recognition that Torres Strait Islanders and the coastal people of PNG need to carry on their traditional way of life. This geopolitical construct is a recognition of the realities. It permits traditional people from both countries to move freely (without passports or visas) for traditional activities in within the zone.

DFAT explains that:

Torres Strait Islanders are allowed to travel north into Papua New Guinea as far as the 9 degrees South latitude line just north of Daru. They are also allowed to visit Parama Island and the villages of Sui and Sewerimabu.

Traditional inhabitants from the nominated thirteen Papua New Guinea coastal villages are allowed to travel south into Australia as far as the 10 degrees 30 minutes South latitude line near Number One Reef.

Traditional activities under the Treaty include activities on land (such as gardening, food collection and hunting), activities on water (such as fishing for food), ceremonies or social gatherings (such as marriages) and traditional trade.

Business dealings and employment for money are not allowed as traditional activities under the Treaty.

Micro-organisms a challenge for border security
In March, 2008, Director of the Australian National University’s Masters of Applied Epidemiology Program at the National Centre for Epidemiology and Population Health Professor Paul Kelly went on record saying that:

The Torres Strait and Australia are running the risk of  a TB epidemic, particularly from the virtually untreatable multi-drug resistant (MDR) and Extensively Drug Resistant (XDR) forms 

In May of that year the Australian Medical Journal published a report stating that as early as 2006 it was known that there was a rising incidence of TB in the Torres Strait and changing TB patterns in Far North Queensland.  The report explained that there was:

Evidence of rising incidence of TB in the Torres Strait and primary transmission of MDR-TB within the Western Province of PNG suggests the potential for a major public health crisis, with the possibility of MDR-TB spreading to northern Queensland.

It called for urgent efforts to increase resourcing, to find further cases and provide appropriate treatment with follow-up for all visitors and residents living in the Torres Strait Protected Zone.

The report also explaind that while Australia has one of the lowest incident rates of tuberculosis (TB) in the world, with rates around 5–6 cases per 100,000 population the. . .  health status of Papua New Guineans is one of the lowest in the Pacific region, and TB is one of the three leading infectious diseases causing death in PNG, with an estimated mortality rate of 42 deaths per 100,000 population. The estimated annual incidence of all forms of TB in PNG is 233 cases per 100,000 population. 

The response on the ground
The Torres Strait Treaty excludes health matters as a valid reason for travel under its freedom of movement provisions, but inadequate medical services in PNG encouraged people from Western Province to travel to the Torres Strait Islands in search or medical care. Both Commonwealth and Queensland health resources seem to have been used in the filling of a PNG health services gap that could have serious consequences for Australia. In July 2008 the Australian Broadcasting Corporation’s (ABC) 7.30 report carried a story on the growing problem. Peter McCutcheon reported that almost . . .  every day, villages from the mainland of Papua New Guinea take a short boat trip to Australia. Some live less than five kilometres away from Saibi, one of the northern most Australian islands in the Torres Strait. 

McCutcheon cited a spokesman from DFAT as saying that : “The free movement provisions of the Treaty do not … permit travel specifically for health purposes. We need to balance this carefully against humanitarian considerations and ensure that all health risks are appropriately addressed.”

A Senate Committee of inquiry
Ultimately there was a Senate Committee of inquiry into this problem.  The Committee made five recommendations, but these are some of the more important ones:

1. The committee recommends that through the Package of Measures developed by the Health Issues Committee, the Australian Government continue to support PNG initiatives to establish new, or improve existing, health facilities in Western Province so that PNG nationals no longer need to seek health care in the Torres Strait.

2. The committee recommends that the Australian Government give serious consideration to measures that would further facilitate the proposal for greater cross-border involvement by Australian health professionals in both the provision of services and capacity building on the PNG side of the border.

3. The committee recommends that the Australian Government use the Papua New Guinea–Australia Partnership for Development to detail the assistance it is providing to PNG to improve the delivery of health services in the southern part of Western Province and to ensure that projects undertaken in this region are appropriately monitored and evaluated during implementation and after completion.

4. The committee recommends that to improve accountability and transparency of Australia’s development aid spending, AusAID’s Office of Development Effectiveness (ODE) conduct an analysis of Australia’s funding in relation to Western Province in the Torres Strait region.

5. The committee recommends that the analysis mentioned in the previous recommendation also look closely at the extent and effectiveness of AusAID’s cooperation with Queensland Health and consider ways to ensure that their work in the Torres Strait region is seamless across the border and that their operations and funding complement each other.

The ABC’s new program 7.30, reported again on the issue.  Peter McCutcheon observing that the Commonwealth and Queensland Governments have decided to shut down vital tuberculosis clinics in the Torres Strait. Experts now fear that the problem could spread to the mainland.  Sadly, this wasn’t one of the Senate Committee’s recommendations.

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