Sep 20

The case of Oshin Kiszko: think before you judge

Oshin Kiszko suffered from Medulloblastoma (brain tumor), pictured with his Mother Angela Kiszko. Photo: Elle Borgward Oshin was described as a ‘fun-loving’, ‘supercharged’ child. Photo: Supplied

Oshin’s parents Angela Kizko and Colin Strachan pay their respects. Photo: Elle Borgward

Oshin’s mum Angela Kiszko fought for what she believed in. Photo: Elle Borgward

Hearts with personalised messages were hung around the Kiszko home on Thursday at Oshin’s memorial service. Photo: Elle Borgward

Six-year-old Oshin Kiszko’s parents made a harrowing choice to refuse consent for cancer treatments, the long-term physical and mental burdens of which they believed outweighed the chances of saving his life.

It led to a state-first Family Court case as Oshin’s doctors attempted to enforce those treatments.

They won, in the case of chemotherapy, but lost it in the case of radiotherapy, a treatment in which the consequences for a six-year-old’s brain development would have been more profound and also would have a diminished likelihood of succeeding given the time that – by then – had elapsed.

Whichever side they were on, all those who cared for Oshin – medical professional, family or friend – had heavy hearts on Thursday. Princess Margaret Hospital staff offered to attend the funeral. The lawyer who represented Oshin’s parents in court turned up to pay his respects.

An issue like this strikes at the heart of any parent, and as such ignited a fierce public debate. As such, it is important to understand the complex factors that led to this outcome.

The first factor was the breakdown in the relationships between the doctors at Princess Margaret Hospital and his mother Angela Kiszko. From the beginning they could not relate well. She thought them pushy and dismissive. It is reasonable to assume they thought her obstinate and lacking in understanding, though we have not been able to interview them, only rely on court affidavits and evidence.

Doctors mostly – and mostly rightly – enjoy something like hero-worship, at least in our culture, by the public and their patients. They are godlike and rarely questioned. It follows that they may not react well when their judgement is questioned by a parent they think is unreasonable, especially if they believe in their own hearts that the delay further explanation or negotiation will take, will put a child’s life at further risk.

When they are questioned, cases generally go to the Children’s Court, where doctors more often than not win, and cases go unreported.

It would be very challenging for a medical professional to remain patient and gentle as such a situation unfolds. And we cannot know what questions the doctors asked themselves before embarking upon the court action. It is certain they did not undertake it lightly.

​It should also be noted that PMH has, since this case, put into place a program aimed at improving parent-doctor communication.

Another factor was the strong beliefs of Oshin’s parents, Angela Kiszko and Colin Strachan, in quality of life over length of life and where it came from – primarily Angela’s history of farewelling close members of her family to protracted and painful battles with cancer. Her mother and her stepmother both had difficult deaths from cancer. This experience, whether comparable or not, understandably shaped Angela’s attitudes towards cancer treatments as much as anything else.

The third factor was Oshin’s personality and his parents’ attunement to it. Oshin was an exceptionally lively child and also held, since he was a toddler, a deep fear of doctors and medicine.

His parents repeated numerous times that they did not object to other parents’ choices to pursue treatment for their own children, and that they only believed treatment was not right for Oshin. They believed the process of such a treatment and its inevitable burdens, physical and intellectual, that would continue in the long-term, would traumatise him more than was humane to inflict on such a boy.

They wanted to protect him.

Whether they were right or wrong is not for me to say. I can only observe that their belief was genuine and passionately held; as was their love.

The final factor was the legal and moral grey area this case represented.

The very phrase, ‘a child’s best interests’, which each party to court proceedings had at heart, is shot through with grey.

It must call into question how one measures ‘best interests’ and we must recognise that its definition can only ever be subjective.

There was never significant medical disagreement in this case; even Professor Stewart Kellie of the Cure Brain Cancer Foundation in Sydney, a witness called upon by Oshin’s parents’ lawyer to support the argument not to enforce radiotherapy, acknowledged that it was primarily an issue of values, not one of a medical grey area.

Ultimately, it came down to the different practices and values of individual doctors; some, like Oshin’s, thought while there was life there was hope and any treatment burden was justifiable with there was a chance to save a life.

Others, including Professor Kellie, would not push parents to consent to radiotherapy on the brain of one so young.

Individuals, whether doctors or parents, all have their own values, and one is no more right or wrong than another, especially as no two cases are the same; something the Supreme Court judge acknowledged in making his own terribly difficult final judgement.

No one in this case should be harshly judged for following the advice of their gut. It is worth remembering that most of the time the shoe is on the other foot, with doctors often having to force parents to accept that throwing further treatment at a suffering child is pointless and cruel, and that the time has come to say goodbye.

Angela Kiszko and Colin Strachan decided to say goodbye before this point arrived.

But it is now time to let go of all the​ disagreement and the​ anger that has surrounded this case.

Oshin is at peace. Those who still have anger and fight should use it to fight these horrendous brain cancers that with brutal swiftness first transform, then claim forever, our loved ones.

Perhaps advances in research will lighten the burden of treatments in some cases almost as horrific as the alternative.

If you really care, make a donation to Cure Brain Cancer.  Follow WAtoday on Twitter

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Sep 20

‘I need you guys to look after my family’: Sudanese refugee Faysal Ishak Ahmed’s final message

Sudanese refugee Faysal Ishak Ahmed, in a white t-shirt, on Manus Island. Photo: Supplied A vigil for Mr Ahmed outside Immigration Minister Peter Dutton’s office on Thursday. Photo: Supplied

 Faysal Ishak Ahmed carried a deep secret and a burning fear during his years in detention on Manus Island, long before he became the fourth asylum seeker to die after seeking protection in Australia and being sent to Papua New Guinea.

His secret was that he left behind a wife and baby boy when he fled Sudan in 2013, having refused to be recruited by the same militias that had tortured him, killed several members of his family and raped his sister.

His fear was that he would never be able to extract his wife and child from their precarious existence in a Sudanese refugee camp and realise his dream of a life with family and without fear.

He felt it acutely back in February 2014, when locals and security guards turned on the detainees inside the Manus detention centre, as he hid under his bed only metres from where Reza Barati was murdered.

All the while, he later told his friends, he was thinking about his wife and little boy, Mazim.

The fear became all-consuming in recent months, as his body wilted, his confidence in the detention centre’s health providers evaporated and he wandered about the centre at all hours, hoping the exhaustion would bring sleep.

When his death was imminent last week, friend Aziz Adam says Mr Ahmed delivered his last message: “If anything happens to me, I need you guys to look after my family.”

“We will do our best,” says Mr Adam, 24, though the Sudanese community on Manus feels incapable of assisting while its members remain in a centre declared unconstitutional by PNG’s highest court last April, still unsure whether they will be included in the resettlement deal with the United States.

What they can do is give their account of what happened to Mr Ahmed, in the hope that it might lead to changes and avert further tragedies.

This is why they entered the tent Mr Ahmed shared with 25 others in Oscar compound and took his most precious possessions from the bag by his bed when word of his death began to spread on Christmas Eve.

Among them was a cache of requests for treatment by International Health and Medical Services, the global company contracted to provide primary and mental health services to detainees on Manus Island and Nauru.

There were also copies of the formal complaints he lodged against IHMS and Australian Border Force, official responses to his requests and complaints, and personal items including a picture of his wife and boy.

At first Mr Ahmed, who spoke little English, had written his requests for help in Arabic, but when time dragged on with little response, Mr Adam says he agreed to translate them into English and read them back to Mr Ahmed before his put his name to them.

“It made me feel a human being,” Mr Adam told Fairfax Media. “He deserved that kind of compassion and support.”

Fearing a cover-up, or that the litany of complaints would not emerge until a coroner’s inquest a year or two from now, the friends took it upon themselves to put the material on the public record.

“We needed to show this is not the way to treat people here,” said one of those who took the documents and provided copies to Fairfax Media. “I want everyone to know no one (in authority) cared about him.”

Among them is the letter signed by the 60 Sudanese detainees “kindly and humbly” pleading with IHMS to help him after he returned from the clinic and informed friends he had been told there was nothing wrong with him.

Two days later, he passed out, fell, hit his head and had a seizure, prompting his transfer to Brisbane, where authorities say he died.

The health provider has since released a statement, expressing concern at “the inaccuracies and misinformation” surrounding the reporting of Mr Ahmed’s death and pride in the work of its “highly qualified and professional clinicians”.

“Claims that the patient was denied access to medical care are not correct. He was seen by clinicians and other allied health professionals at the clinic on numerous occasions in the three months preceding his death for multiple issues and his presenting medical issues were assessed, investigated and managed,” the statement says.

“The facts and circumstances surrounding his death will be referred to the Queensland Coroner. However, currently available information indicates that Mr Ahmed died from severe head injuries sustained in a fall at the Manus Island Regional Processing Centre on 23 December.”

Fairfax Media has interviewed several of the detainees who contest the IHMS assertions. They insist Mr Ahmed was the victim of what Dr Barri Phatarfod, president of Doctors for Refugees, has dubbed “a culture of cynicism among at least some of the IHMS health professionals”.

Dr Phatarfod has provided Fairfax Media with one referral from IHMS for an asylum seeker who had cracked the right lens in his glasses and complained that he could not see out of his left eye. A test had not been done to assess the left eye, the referral asserted, “as they exaggerate their acuity to get attention”.

Astonishingly, the referral was dated September 7 2014, the day after the life support machine for Iranian asylum seeker Hamid Khazaei, was switched off in the Brisbane hospital.

Mr Khazaei died 13 days after presenting at the Manus Island detention centre’s medical clinic with an infected foot. A coroner’s inquest into his death will reconvene in February.

“Faysal was sick and had heart problems for more than six months but IHMS, the company that is responsible for our health, did not care about him and did not provide any treatment for him,” says an open letter signed by more than 200 detainees.

What is beyond question is that Mr Ahmed’s mental and physical health deteriorated dramatically during his more than three years in detention.

Rohingyan refugee, Imran Mohammad, 22, met Mr Ahmed when they were in the same compound in 2013 and says he was “full of life” and very engaging, with no health issues at all.

They did not cross paths again until recently, when they were again in the same compound, and Mr Mohammad says Mr Ahmed was withdrawn, had lost a lot of weight and was clearly very ill. “He was a different man,” he says.

Having survived more than 10 years as an internally displaced person in Sudan and witnessed all manner of horrors, Mr Ahmed began to fall apart on Manus after his claim for protection was accepted in October 2015, some eight months after his “initial positive assessment”.

The chest pains, stomach aches, dizziness and breathing difficulties became more pronounced in the last six months, after Mr Ahmed learnt that his mother had died in the Sudanese refugee camp.

In his application for protection, Mr Ahmed told how his village was attacked by the militia in 2003. “Around 35 people were killed during the attack including my brother, Abubakar, my grandmother and my uncle. My uncle was slaughtered by the militia when he refused to give up his camels.”

The family escaped to a refugee camp where Mr Ahmed lived with surviving family members until he fled in July 2013. “It was not safe in the camp,” he explained in his application for protection.

“On many occasions the Janjaweed militia entered the camp and killed people… They raped my uncle’s daughter. My sister was also raped. In one occasion in 2003, I was handcuffed and tied to a tree for two or three days. I was beaten badly. I have a scar on my left forearm where the handcuff was and scars on my forehead where I was whipped.

“The militia wanted me to join them as a fighter but I refused.”

Mr Adam says all the Sudanese refugees have similar stories. “All of us in the Sudanese community living on Manus Island detention centre, we have been experiencing the same trauma and torture, the same nightmares. We prefer not to talk about it because it’s painful.”

Now they are devastated. “This is Christmas and we were hoping for a gift from the Australian government, like our freedom. All we got was a dead body,” he says.

When Mr Khazaei died in 2014, then immigration minister Scott Morrison said his department’s chief medical officer would be conducting an “in-depth clinical review” of the Iranian’s medical treatment while on Manus Island.

This time the only official comment has been a brief statement on the Border Force website, saying the department is not aware of any suspicious circumstances and the death will be reported to the Queensland Coroner.

Those still detained say this is not good enough and, in their open letter, have called for a royal commission to investigate Mr Ahmed’s death.

One of those still detained is the Iranian Kurdish journalist Behrouz Boochani, who recalls that a similar open letter was written at the time of Mr Khazaei’s death, and that it concluded by asking who the next victim would be.

Mr Ahmed was among those who put his name to the letter.

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Sep 20

Cory Bernardi accuses Tony Abbott of ‘self-interest’ and ‘talking up division’

Cory Bernardi wants Trump-style political change. Photo: Alex Ellinghausen “The conservative instinct is to fix things, not to junk them”: Former prime minister Tony Abbott. Photo: Louise Kennerley

Liberal senator Cory Bernardi has taken aim at ally Tony Abbott over his censure of “rebellious” colleagues looking to “do a Trump” in Australia, accusing his former leader of “talking up division” and backing “the horse named self-interest”.

Mr Abbott took to The Australian newspaper to pen a warning to Liberal colleagues looking to form a breakaway conservative party, predicting it would be a success, but one which would ultimately deliver government to Labor.

The former prime minister did not name Senator Bernardi in his missive, but the backbencher has increasingly been agitating for change, more recently refusing to hose down talk he is looking to form his own movement separate to the Liberal Party next year.

But Senator Bernardi dispensed with any opaqueness, naming Mr Abbott openly in a tweet responding to his opinion piece.

“While most on break, [the] only person talking up division in [the] Lib Party this past week is Tony Abbott,” he tweeted on Friday morning.

“Always back the horse named self-interest.” While most on break only person talking up division in Lib Party this past week is @TonyAbbottMHR. Always back the horse named self-interest— Cory Bernardi (@corybernardi) December 30, 2016

Senator Bernardi has also said he will have more to say in the New Year, having promised a “massive” 2017.

He has said Donald Trump’s victory in the United States served as a form of political epiphany for him, inspiring him to be a “catalyst for change” in Australia.

The rise of One Nation and continued falling support for the Turnbull government has also emboldened the Coalition’s more conservative members to speak out more and more, with George Christensen also warning his loyalty has limits.

Senator Eric Abetz said the answer was to reform the party, rather than divide it, while issuing his own warning to leader Malcolm Turnbull and the NSW branch of the party.

“A split within the Liberal Party would potentially dilute the conservative voice which would slow the momentum for reform in the NSW division,” he said on Friday.

“Many conservatives have been manipulatively disenfranchised by certain operatives in NSW which has led to understandable and widespread dissatisfaction.

“The answer is to remain and reform the party rather than dilute the forces for democracy and reform. Australians are entitled to a strong centre right political force and any split would weaken it. This is neither in the national interest nor the interests of the Liberal Party. The leadership of the party needs to be more proactive in reaching out to the majority of our membership to forestall such a potential split.”

Special Minister of State Scott Ryan was more gentle.

“The breadth of the Coalition, the fact we represent communities from right around Australia with very different life experiences, with different views – that is our strength,” Senator Ryan said.

“Unlike the Labor Party, we’re not factional Daleks. We have different views and we air every case.”

Parliament will resume in February.

with Tom McIlroy

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Sep 20

Sydney weather: Another muggy night on the way

At Circular Quay, people reach for gelato, doing what they can to deal with the excessive heat. Photo: Cassandra Hannagan Barry Moore 69 from Leichhardt escapes the heat with a morning swim at the Dawn Fraser Baths in Balmain. Photo: Kate Geraghty

People enjoying the hot weather over the holiday period at Coogee. Photo: Ben Rushton

Prepare for another night of tossing and turning, temperatures for Sydney are forecast within the 30s as late as 9pm on Friday night according to Weatherzone.

“Similar to last night, we’re not really looking like we’re going to cool off much overnight,” said Rebecca Kamitakahara, meteorologist at the Bureau of Meteorology.

Thursday night’s minimum temperature at Penrith was 24.7 degrees, which was its warmest night since February. The city didn’t enjoy much more relief, with the temperature only dropping to 23.9 degrees.

“So at Penrith overnight [Friday] we’re only expecting it to drop down to 25 degrees, and in the city we’re only expecting it to drop down to 24 degrees,” Ms Kamitakahara said. “So another muggy night on the way unfortunately.”

Sydneysiders are suffering through another hot day, with the Bureau of Meteorology forecasting temperatures to climb to 35 degrees in the city and 38 degrees in the west on Friday.

Showers and possibly some thunderstorms are expected to move across the Sydney basin in the afternoon and evening.

The greatest risk for showers is from about 4pm through to midnight, according to Weatherzone meteorologist Graeme Brittain.

“Humidity is going to be quite high with these showers as well,” he said.

“It will be quite uncomfortable conditions for sleeping as we move into this evening and overnight.”

A southerly wind change early on Saturday morning will mean that temperatures in the city won’t be quite as hot as Friday, with a forecast top of 28 degrees.

Western Sydney won’t be feeling this change though, with temperatures expected in the mid 30s again during the day on Saturday.

New Year’s Eve will be a fairly cloudy day with a chance of showers or thunderstorms in the afternoon, and possibly during the evening.

Mr Brittain said that while it will be cloudy, it is not expected to be low cloud cover, “So people should still be able to see the full fireworks display.”

Winds are expected to remain light through to midnight, so should not be a hindering factor to maximum firework enjoyment.

According to Weatherzone, the first day of 2017 is expected to bring showers and possibly a thunderstorm, as well as some hope for heat affected Sydneysiders as temperatures continue to drop.

The western suburbs are looking at a forecast top of 32 degrees while the city is expected to reach the high 20s.

Weatherzone is owned by Fairfax Media, the publisher of The Sydney Morning Herald.

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Sep 20

Queensland Rail to deliver report into Christmas Day cancellations

Jackie Trad has confirmed a report into QR’s Christmas Day failures will be handed in on Friday. Photo: Chris Hyde Acting Premier Jackie Trad says she has faith that Transport Minister Stirling Hinchliffe will sort out Queensland Rail issues. Photo: Jorge Branco

The Queensland government will receive a report into the Christmas Day rail fail on Friday, although it will not be made public until besieged Transport Minister Stirling Hinchliffe has “digested” its contents.

Acting Premier Jackie Trad confirmed Mr Hinchliffe would receive the report on Friday into “what actually went wrong” when 235 services were cancelled on Christmas Day.

“He has made a commitment to release relevant information publicly, when he gets the report and he’s had time to review that report and digest it,” she said.

“I do know that the public is deeply, deeply interested in this, as is the government, we will make sure that the interest that is in the public benefit is released in relation to what happened on Christmas Day.

“There may be some issues relating to confidentiality, I’m not sure, I think he needs an opportunity to receive the report, to review it, and then make that decision [into how much will be released publicly].”

Mr Hinchliffe and Queensland Rail acting chief executive Jim Benstead have been reluctant to “guarantee” train services would run smoothly on New Year’s Eve.

But Ms Trad was willing to give a guarantee of a different sort when asked if Mr Hinchliffe would still have his job in 2017.

“I can guarantee that Stirling Hinchliffe will do the job that the Premier has asked him to do,” the Deputy Premier said.

Ms Trad apologised to passengers on behalf of the government for the inconveniences experienced as a result of the Christmas Day debacle.

“I do know that Minister Hinchliffe has been working very hard over the past number of days to make sure that New Year’s Eve celebrations are not disrupted in the same way,” she said.

“I know he’s had a number of briefings, he’s required Queensland Rail to provide him with specific information.”

Ms Trad said the rosters were full for New Year’s Eve services and Mr Hinchliffe had kept her updated.

“I can guarantee that the minister is working very hard, but there might be a fault in one of the lines, there might be a tragedy on one of the lines, because of all of these things, because of human nature, you cannot absolutely guarantee that every single train will run as planned,” she said.

In October 2015, a whistleblower contacted Ms Trad’s office warning of a looming driver shortage, when she was the transport minister.

Ms Trad said the information provided by the caller was not consistent with information being provided by Queensland Rail at the time.

“In fact, less than a month after, that call which was from an anonymous individual, Queensland Rail embarked upon the recruitment of 100 train drivers and 100 guards,” she said.

“Some four weeks after that there was a change in ministry.

“In terms of the information, the handover to Stirling Hinchliffe, I did outline as I have detailed in the past, the issues that Queensland Rail had advised me may be of concern in terms of the 2016 train issues.

“It was general issues, I did advise, in part of the incoming briefs, Stirling would have been advised that a recruitment process had been underway.”

Ms Trad said she believed chief operating officer Kevin Wright made the right decision in resigning.

“The minister has said that in relation to the Christmas Day rostering debacle, it was an issue in relation to the management of the rostering system,” she said.

“So management needed to take responsibility for that rostering problem and I think that given everything that happened on Christmas Day, the late notification, the spike in cancellations, it was incumbent on the minister to make some hard calls and I think he made the right call.”

Ms Trad said once the Philip Strachan review was received at the end of January, the government would look at the recommendations and make any necessary changes.

Acting Opposition Leader Deb Frecklington said Queenslanders deserved to know what was in the report on the Christmas Day fiasco.

“I can tell this minister that the people of south-east Queensland would like also to digest this report and see the contents of his failings on Christmas Day,” she said.

“This is a minister that continues to play the blame game… This is now the third QR executive we’ve seen go on this incompetent minister’s watch.”

Ms Frecklington said it was not good enough that Ms Trad and Mr Hinchliffe had “refused to guarantee to the commuters of south-east Queensland that they’re going to be able to turn up to their party on time on New Year’s Eve”.

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