Tens of thousands of school students visit the Australian War Memorial every year – more than 95,000 in 2022-23 alone. For students in Years 4-12, a visit to the Memorial is mandatory for the school to receive federal funding for a visit to Canberra. (more…)
Kim Oates
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Professionalism and compassion in healthcare
We don’t have to take off our compassion, or our ability to show it, when we drape a stethoscope around our neck. The need for doctors to be professional is not synonymous with being emotionless. (more…)
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Bringing Australian children here from Syrian refugee camps is just the start
Our government is doing the right thing. But bringing Australian children in Syria to Australia without an individualised long-term plan of support for each child will achieve little. The complexity of the task to help these children must not be underestimated. It will be a long process and a long-term investment, but it will be worth it. (more…)
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Children suffer the most in war
The nightly television coverage of the war in Ukraine is increasingly bleak. We see a distraught mother who has lost all her possessions. The camera moves to her three-year-old daughter in a pink coat, playing while her mother speaks. She seems happy enough. We are tempted to think ‘At least the children are OK’. But the children are not OK. In war it is the children who suffer the most. (more…)
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We aren’t just laggards in Covid immunisation
I recently watched the superb film “Jimmy Carter, Rock & Roll President”. It is available on SBS. It’s not about politics. It’s about the man. Watch it, enjoy the fabulous music and interviews with the music legends he befriended. Then weep. Weep for a time when honesty, integrity, self-effacement, and sincere humility were the consistent hallmarks of a fine political leader. (more…)
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Australian government’s refusal to recognise 2017 Nobel Peace Prize winners a stain on decency
On 22 January, the Treaty on the Prohibition of Nuclear Weapons will put nuclear weapons in the same category as other banned inhumane weapons including biologic and chemical weapons, cluster bombs and antipersonnel land mines. This was largely the work of ICAN, the International Campaign Against Nuclear Arms.
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Let’s all shout out for our nurses in 2021
During COVID-19, it is the nurses who are predominantly in the front line. Doctors can come into a ward, see patients and then move on. The nurses stay there. They are the ones most exposed to infection. They put their lives on the line. And they are true professionals, to be valued and respected. Let’s celebrate them
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In this pandemic, children will suffer far more than we realise
We are told, quite correctly, that one of the few bright spots of the Covid-19 pandemic is that children are at significantly lower risk of being infected, and less likely to have a severe illness should they become infected. But this is only part of the story. (more…)
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KIM OATES. Anxiety and the Etiquette of Walking
When we meet people walking towards us, have you noticed how anxious many look? Anxiety can be damaging to mental health. What can we do to help reduce damaging anxiety? (more…)
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KIM OATES.-COVID-19. Good news and bad news for children
There is good news for most children and bad news for some in this pandemic. Unlike most epidemics, where those at both ends of the age spectrum are more likely to succumb, the good news is that we are seeing a smaller proportion of deaths and infections in children. (more…)
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KIM OATES. Ten questions patients should ask their doctor.
Although patients are the people who have the best knowledge of themselves and their particular concerns and who obviously have a strong interest in achieving a good outcome, they are often reluctant to ask their doctor questions. (more…)
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KIM OATES. An insidious tragedy
Imagine what would happen if a fully laden 747 airliner crashed in Australia every week for a whole year. There would be public outcry, an outrage, swift political action and an enquiry at the highest level, possibly a Royal Commission.
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KIM OATES. If we listened to children the world would be a better place
Last week was National Children’s week, with a theme that children’s views and opinions should be respected, that they have a right to be heard. (more…)
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KIM OATES. Viewpoint: “Always say something positive about the child” (Berry Brazelton 1918-2018)
Over 40 years ago, I was fortunate to do some of my paediatric training with Berry Brazelton. He wasn’t famous then, but there was something about him that set him apart from the purely organic focus of most of the senior staff at Boston Children’s Hospital. He was interested in babies as individuals with their own sets of skills. Here was a paediatrician prepared to question the status quo about the abilities of infants and young children who based his views, not on the prevailing dogma, but on careful observation. He was the first to recognise that a baby is a highly developed human, even when just newly born. (more…)
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KIM OATES. The Royal Commission, a beginning, not an end.
The Royal Commission into Institutional Responses to Child Sexual Abuse is testament to both the evil in our society and to the courage and determination of many of the victims. But we need to be aware that most child sexual abuse occurs in places other than churches and institutions. (more…)
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KIM OATES. Infections in healthcare: common but eminently preventable
Infections acquired in hospitals are a major contributor not only to avoidable deaths but also to the cost of health care. Among preventative measures the simple but often neglected practice of hand-washing stands out. (more…)
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KIM OATES. The health gap.
“The problem is ………. that we have been pursuing economic policy that benefits the one per cent. Trickle-down economics is defunct and does not work”.
“Politics quickly departs from evidence into the realm of ideology ….. But evidence must be a key part of the conversation.”
“One senior Conservative politician in Britain put it to me that my agenda is closer to Social Democrat than to Conservative thinking …… I make my case on the evidence, not on prior political beliefs.”
These quotes are from Michael Marmot’s book, The Health Gap. Some may find them controversial, or at least provocative. (more…)
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KIM OATES. Respecting patients and keeping them safe
Some words of advice from Kim Oates for doctors and other health workers. The patient is the reason for health services. Health workers are means to that end. (more…)
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Kim Oates. Excuse me doctor, have you washed your hands?
Imagine you are a patient in hospital. The doctor draws back the bed sheet to examine your abdomen. Before you are touched, you say “Excuse me doctor, have you washed your hands?”
Would you dare? Would you be too embarrassed, awkward or even afraid to ask? Would you worry that it would be rude to ask, or that it could undermine the doctor’s authority? Would you risk upsetting the person taking care of you if it led to your doctor taking offence? Or you might think it’s just not your role to ask this type of question.
Hospitals can be dangerous places. Sometimes things go wrong and patients suffer. Dr Don Berwick from the Institute for Healthcare Improvement in Boston showed that the risk of death from hospital admission was the same as the risk of death from mountain climbing or bungy jumping. But of course, because hospital admissions are far more common than these sports, the actual number of deaths is far higher.
One reason for this is that people admitted to hospital are often unhealthy to start with. They may have multiple health problems. Some have supressed immune systems, making them more susceptible to infection. They may undergo complex procedures where there are small margins for error.
Another less apparent reason is that not all health professionals practise hand hygiene as well as they should.
According to the Australian Commission on Safety and Quality in Healthcare, each year approximately 200,000 patients acquire an infection while they are in hospital, making hospital acquired infection the most common complication for hospitalised patients.
Sometimes these infections can enter the blood stream, with the potential to cause death, particularly when the infection is from an organism resistant to most antibiotics. And hospitals are places where antibiotic resistant bacteria are more commonly found.
Hand hygiene is probably the most important thing health workers can do to protect their patients from infection.
But what can patients do to protect themselves? Asking health professionals if they have washed their hands is a good start.
Studies show that a substantial minority of health professionals don’t wash their hands as often as they should, although concerted campaigns, coupled with surveillance, by Hand Hygiene Australia and other patient safety bodies show that compliance with hand washing is increasing.
In 2010, 70% of nurses complied with hand washing regimes, the highest of all health professional groups surveyed. By 2105, their rate had risen to 86%. But would you rest easy if you knew that there was a 14% chance that your nurse was one of those who had not performed correct hand hygiene?
Doctors comply less often. In 2010 the hand hygiene rate for doctors was just under half, a worrying 49%. By 2015 their rate had risen to 71%. It’s a big improvement but doesn’t help if you are the patient of one of the 29% who has not complied.
What can you, the patient, do about this? The answer is simple in theory, but difficult in practice. Just ask: “Have you washed your hands?”
However, studies show that 77% of patients would feel uncomfortable asking their doctors if they have washed their hands before examining them. Fifty seven per cent said that they would not ask, assuming the doctor had already washed. Twenty per cent worried that asking could be construed as questioning the doctor’s professionalism.
Contrast this information with what health professionals think about being asked this question by patients. Twenty nine per cent said they would not like to be asked. Twenty seven per cent said they would find it humiliating if they were asked.
This essential question is not the responsibility of the patient or of the health professional alone. The best health care occurs when there is a partnership between the patient and the health professional.
Patients need to know it’s OK to ask the question. Health professionals need to encourage them to ask. Ninety two per cent of patients said they would be more likely to ask the question if the health professional invited them to ask the question, such as by wearing a badge saying “Ask me if I’ve washed my hands.”
Patients need to be encouraged to ask and health professionals need to become more comfortable with patients who ask the question. If the aim of health care is to improve the health of the patient, rather than make it worse, it’s pretty obvious.
Kim Oates is an Emeritus Professor at Sydney University and a clinical advisor to the Clinical Excellence Commission
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Kim Oates. Don’t forget children when talking about domestic violence
Children are victims of domestic violence too.
Last week the Children’s Commissioner released this year’s children’s rights report. It provided new data about the prevalence of child physical and sexual abuse and their links with domestic violence.
Christmas, traditionally a time of peace and goodwill is sadly, a time of increased domestic violence, thought to be due to increased alcohol consumption and family gatherings where there can be the potential to cause resentment and open old wounds.
Our awareness of the extent of domestic violence has been slow in coming. It parallels the way awareness of child sexual abuse came about almost 40 years ago.
When I was a medical student attending psychiatry lectures in 1966, our very eminent professor of psychiatry mentioned that sometimes men sexually abused girls, but that this was very rare. He explained to us that it often occurred at the instigation of the mother who, not wanting sex, pushed her daughter forward instead. Like good students we took notes and learned this “fact” in case it came up in an exam. We did not realise how outrageous and how wrong this teaching was.
Then in 1977 a US paediatrician, Henry Kempe wrote a seminal paper “Sexual abuse, another hidden paediatric problem”. He documented what happens to these children, that it happens in outwardly respectable families, that it is not the child’s fault or the mother’s fault and that it is not rare. Kempe wasn’t the first to describe the sexual abuse of children but having described “The Battered Child Syndrome” 15 years earlier, his stature was such that when he wrote, people took notice.
Brave victims came forward and spoke of their childhood experiences. Other prominent women, social workers and concerned paediatricians spoke about the problem. A backlash followed. There was denial about its extent. Child victims were accused of fabricating stories. It took many years until the community became aware that this was a serious and widespread problem for the whole of society and that prevention as well as treatment and care for the victims was needed.
The awareness of domestic violence has been similar, although occurring much later. For many years it was swept under the carpet, considered to be family business, “better not to get involved”. Victims were blamed as if it was their fault. Police did not give it high priority.
Like child sex abuse, it was a problem that made us feel uncomfortable, a problem we’d rather not know about, a problem that perhaps occurred in “other families”, but certainly not amongst people we knew.
It took some horrific cases, it required concerned women who set up refuges, and it needed brave victims, such as Rosie Batty, to speak up. Only now are we becoming aware of the extent and seriousness of domestic violence, violence that on average causes the death of at least one woman each week and causes physical and psychological harm to countless others.
So what about the link between domestic violence and the abuse of children? We used to teach that they had little in common. Now we know that domestic violence has very serious effects on children.
Children who witness domestic violence can have a range of reactions. Some become fearful, living in constant anxiety, some may feel guilty that they are unable to protect their mother, some feel guilty because they still love their father and they just want him to stop. Others become aggressive. Some learn that this is the way fathers behave towards their wives, leading to the possible intergenerational transmission of domestic violence if this is the only role model they are exposed to.
And then there is the physical and sexual abuse of children in families where domestic violence occurs. Research has shown that between 45 per cent and 75 per cent of women living in refuges report some form of abuse to their children, whether it be physical, emotional or sexual. Other studies suggest that approximately 60 per cent of child physical abuse occurs in homes where there is family and domestic violence. Sometimes a perpetrator uses violence against his partner to prevent her from revealing that he is sexually abusing her child.
It is ironic and sad that the home, where one expects to be safe, can be the most dangerous place of all for some women and children.
With Christmas approaching, this is yet another reason not to forget the children.
Kim Oates is an Emeritus Professor of Paediatrics at Sydney University and a past president of the International Society for the Prevention of Child Abuse and Neglect.
This story was found at: http://www.smh.com.au/comment/dont-forget-children-when-talking-about-domestic-violence-20151216-glo9js.html
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Kim Oates. The Forgotten Children
I have just read the report of the Australian Human Rights Commission on Children in Detention “The Forgotten Children”.
It is clear, factual and unemotional. It is supported by evidence and is non-partisan. It is not on the side of any political party. It is on the side of children.
It made me ashamed about what is being done to these children. It made me sad that our nation can be so cruel. It made me angry about the way the two main political parties responded on the release of the report. The Labour Party was largely silent, although much of what is documented in the report occurred on their watch. The Liberal/National party was belligerent, ignoring the seriousness of the message, blaming others while simultaneously congratulating themselves and trying to shoot the highly respected messenger, Professor Gillian Triggs.
I have not visited a detention centre. But I am a paediatrician and have wide experience in child protection and with disadvantaged children. I know the devastating effects of abuse and deprivation in childhood, effects which often continue throughout life.
I know the paediatricians who gave evidence to the inquiry. They are highly regarded in the medical community. They are not political people, they don’t exaggerate. They care about children.
The inquiry was established to investigate how life in immigration detention may affect the health and development of children. It interviewed 112 children and their families about the health impacts of detention, using a standardised questionnaire. It held five public hearings and received 239 submissions.
One of its aims was to see if Australia met its international human rights obligations, such as: appropriateness of facilities where children are detained; measures to ensure their safety and provision of education, recreation and health services.
Having pointed out that mandatory immigration detention, especially of children, is contrary to Australia’s international obligations, the report states “It is troubling that members of the Government and Parliament and Departmental officials are either uninformed, or choose to ignore, the human rights treaties to which Australia is a party”.
The report noted that our leaders, while talking about the value of detention as a deterrent, do not believe this themselves: “As the medical evidence has mounted over the last eight months of the Inquiry, it has become increasingly difficult to understand the policy of both Labor and Coalition Governments. Both the Hon Chris Bowen MP, as a former Minister for Immigration, and the Hon Scott Morrison MP, the current Minister for Immigration, agreed on oath before the Inquiry that holding children in detention does not deter either asylum seekers or people smugglers. No satisfactory rationale for the prolonged detention of children seeking asylum in Australia has been offered”
The Australian Government’s own Early Years Learning Framework describes three foundations as the basis for healthy childhood growth and progress for pre-schoolers: ‘Belonging, Being and Becoming.’
The first foundation, “Belonging” points out that pre-schoolers need to belong to a family and a community if they are to establish secure relationships and a healthy sense of self.
However the report says “All evidence to this Inquiry indicates that the institutionalised structure and routine of detention disrupts family functioning and the relationships between parents and children. Children do not have access to a private family home where it would be expected families would spend time away from other people sharing meals, engaging in shared activities, and having rest-time on their own.”
The second foundation, “Being” emphasises play-based learning because play provides the most appropriate stimulus for brain development, that childhood is a special time in life where children need time to play, try new things and have fun.
There was little evidence of this need being met for children in detention.
“My youngest child has no toys. He only pushes a chair around” said one mother.
The third foundation ‘Becoming’, is about the learning and development that young children experience. But the most common concern of parents was that their children had little opportunity to learn socialisation skills. Many reported that their pre-schooler was unable to get along with other children.
These three foundations, established by our government for healthy child development are denied children in detention, children who are under the guardianship of the Minister.
The inquiry clearly showed that detention was bad for the mental health and wellbeing of children. Almost all children and their parents spoke about their worry, restlessness, anxiety and difficulties eating and sleeping. Thirty four percent of children had mental health disorders that, if they were not in detention with limited health services, would require referral to a specialist child mental health service for psychiatric treatment. This compares with less than two percent of children in the Australian population.
Children were reported to experience tearfulness, anxiety, delayed or absent speech, regression in behaviour and nightmares. Observers noted tantrums, sleep disturbance, poor concentration, frustration and agitation. One mother told the enquiry:
“My daughter is 2 years old. Five months ago she started behaving abnormally. She wakes up screaming and crying in the middle of the night. She always hits us; she pulls my hair and scratches our faces. She has tantrums every day. She broke my glasses. She gets upset without any reason”.
The Royal Australasian College of Physicians submitted their concern about ‘the long-term impact of detention on children, noting that the ‘psychological distress resulting from detention can persist for years after release’.
The Royal Australian and New Zealand College of Psychiatrists stated “… detention of children is detrimental to children’s development and mental health and has the potential to cause long-term damage to social and emotional functioning.”
This report needs to be taken seriously. It should not be used as an opportunity to blame. It is an opportunity to right a wrong. It is about protecting children.
Kim Oates is Emeritus Professor of Medicine at the Sydney University Medical School. He was formerly Chief Executive of the Sydney Children’s Hospital at Westmead.
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Child sexual abuse: who are the abusers? Guest blogger, Professor Kim Oates
The awareness of the existence of child sex abuse, particularly its frequency, has only occurred in relatively recent times. Now, we read or view daily stories about it. Whether this widespread public awareness of the problem has done much to prevent it and to help the victims is questionable, but it is better than our previous state of ignorance.
Child sex abuse is not a new phenomenon. There is no good evidence that it is more common now than in the past. However, before it started to be studied and publicised in the 1970s, it was hardly ever recognised and rarely discussed. This was mostly due to two factors.
The first is that child sex abuse is done in secret. There are no corroborating witnesses. Only the victim and the offender know about it and the child’s secrecy is often bought with threats of dire consequences if the child ever reveals what has been happening to her. If a child ever found the courage to say she had been sexually interfered with, she usually wasn’t believed. Instead, she was likely to be punished for saying such a terrible thing. This is still a problem for many children today.
The second factor is denial. Child sexual abuse is an unpleasant topic. It is a fact too hard, too unpleasant for most people to entertain or comprehend. In the past we didn’t see it, we didn’t recognise it and we didn’t believe it when we were told about because that made life too uncomfortable, too threatening.
We are no longer ignorant but there is still a degree of denial. We now know it exists but we want it to be somewhere else, something that involves other people, other families, other institutions just as long as it’s nowhere near us.
The much needed Australian Royal Commission into Institutional Responses to Child Sexual Abuse may reinforce that view in the community and give us some degree of comfort that child sex abuse is someone else’s problem, not ours.
However, a wide body of research, including research done in Australia, shows that most sexual abuse of children, boys as well as girls, occurs in or near their own homes, committed by people they are related to, who they know or who their families trust.
Seventy five per cent of child sex abusers are people the child knows and trusts. Contrary to some views, most offenders are not fathers. Approximately 15% are fathers or stepfathers, 30% are other male relatives of the child, 15% are family friends and 15% are acquaintances of the child and family. The remaining 25% of child sexual abuse offenders are strangers who have not met the children before.
It is the group of 15% of offenders who are acquaintances of the child and family which includes those adults who have access to children in religious and other institutions and who use that trust to abuse a child.
The current focus on the response of institutions to child sexual abuse is timely. It is essential. But let’s not forget where most child sexual abuse occurs. The uncomfortable fact is that for most children who are sexually abused, the abuse occurs in or near their own homes. And it is caused by people they know and who their families trust.
Professor Kim Oates