The death of three young children in separate incidents in three different states has left hospitals across Western Australia, Queensland and Victoria scrambling to conduct reviews of policies and procedures.
The tragic deaths that came within a year of each other share commonalities which show just how vulnerable Culturally and Linguistically Diverse (CALD) families are, when forced to navigate an overstretched, underfunded and under-resourced health care system.
The three children, all of Indian heritage and aged between 5-9 years old died after receiving inadequate treatment at the hospital while their parents struggled to get help from medical staff.
It is no secret that the public healthcare system has been struggling in recent times. Faced with the pressures of chronic under-funding, under-resourcing, and an ever-increasing patient load, it was stretched to breaking point when the COVID pandemic hit.
Around Australia, it led to a serious understaffing of doctors and nurses as skilled migration came to a halt. Hospitals and especially emergency departments were overrun by critically ill patients and the availability of ambulances and hospital beds was at a record low.
The system has supposedly been limping back to its suboptimal normal in recent months but the issues with understaffing and inadequate triage in emergency rooms persist, worse than ever before. It is only obvious that there would be mistakes made, and some with dire consequences when the hospitals are so overwhelmed.
However, it is against the backdrop of this failing system, that we need to understand the impact on migrant and culturally diverse families and how they end up at the worse end of the outcome spectrum. Medical paternalism is an attitude that’s well on its way out but in the instance of migrant communities, this attitude persists as is.
Unheard, misunderstood and ignored in modern-day Australia, parents of three children seek answers that will do little to ease their unfathomable grief.
On the 3rd of April,2021, 7-year-old Aishwarya Aswath was brought to the Perth Children’s hospital by her parents. She had been complaining of stomach pain and a headache.
A perfunctory triage that completely ignored her parents’ obvious concern scored her as a low-risk patient. Although she was meant to be examined by medical staff within one hour, this did not happen for almost two hours.
Aishwarya’s condition began to deteriorate in the waiting room, and her distressed mother approached the triage desk five times for help. Each time she was turned away with the assurance that the child would be attended to, soon.
The medical staff failed to record the parent’s visible concern and agitation even as her mother spoke to various members about unusual discolouration in her child’s eyes, her floppy limbs and ice-cold extremities.
Aishwarya was finally seen by a doctor a couple of hours later, but it was too late. She went into cardiac arrest and could not be revived.
The hospital launched external and internal reviews into the events leading to her death and the results have been made public.
Recommendations include improving triage processes, escalation pathways for parents, and a review of cultural awareness amongst staff when treating CALD families.
The report also noted that there is an inadequate recording of data on the needs of CALD families across Western Australia.
Aishwarya’s parents slammed the findings of the review saying that the critical question of “Why were we not heard” has still not been answered. How did a mother’s distress caught on CCTV camera as she paced the emergency room floor not register with the staff?
While Aishwarya’s case made national headlines, similar tragedies were waiting to unfold in two other states.
In late April 2022, just a year after Aishwarya’s death,
Little Amrita Lanka was taken to Monash Children’s hospital in Melbourne after complaining of a stomachache. She had to wait for two hours to be assessed by medical staff and was then diagnosed with gastroenteritis. Her parents were told that she would be discharged soon.
However, her condition began to worsen, and she developed breathing difficulties. Her distraught mother approached medical staff on numerous occasions only to be told that her daughter had an empty stomach which was causing laboured breathing.
After six hours of struggling to breathe and repeated requests for help, she was finally seen by a doctor and a blood test was performed.
The results revealed that she was dangerously ill.
She went into cardiac arrest shortly thereafter and passed away 21 hours after having arrived at the hospital.
Less than a month after Amrita’s death,
Five-year-old Hiyaan Kapil was referred to Logan hospital in Queensland by a GP. The child had severe stomach pain and had been vomiting.
The parents were told that the child had gastroenteritis and despite their requests for IV fluids, the child was not given any. Shockingly, he was discharged from the hospital despite witnesses claiming that he looked extremely unwell.
His parents’ vocal protests were ignored, and they were made to take him home.
Less than two hours later, he collapsed at home and was rushed back to the hospital where he was unable to be revived and declared dead.
Both Monash and Logan hospitals have promised a full review of the matter.
However, there is already enough damning evidence that the common theme across all three deaths is a complete dismissal of parental concern, and an inability of hospital staff to recognise and register the distress and anxiety of parents from ethnically diverse backgrounds.
The last two incidents are especially alarming and distressing.
Despite recognition of the fact that migrant parent voices were not heard in Aishwarya’s case, there was no nationwide recommendation for paediatric hospitals to review their policies when treating CALD patients.
A review is so much more effective when conducted prior to a mishap.
While there is no denying the fact that the hospitals are overwhelmed, it is not acceptable that patients from a certain background suffer such devastating consequences.
It is imperative to further examine the implicit or unconscious bias that exists in the medical community when treating patients belonging to a CALD community.
The question that whether Australian medical professionals tend to treat complaints from patients of diverse backgrounds less seriously than the local population, needs to be thoroughly examined.
Adequate training to remove this bias is not only a step toward ensuring equality and fairness, but it may also well be what is required to ensure no parents goes through such devastation again.
It is perhaps equally important to educate parents about their rights in the hospital, especially if they feel they are not being heard.
Parents and carers in Queensland can invoke Ryan’s rule which allows them to request an urgent clinical review if they feel their child or ward is deteriorating and is not getting adequate care. This rule has been credited with many positive outcomes in Queensland Hospitals.
However, the knowledge that the rule exists is key for parents to be able to invoke it.
Other states have different variants of this rule.
In Victoria, the Hear Me program and in NSW, REACH programs are in place for parents to request immediate additional assistance while in hospital.
Whether the eventual outcome would have been any different, had the three children been treated appropriately, within recommended time frames, is a difficult question to answer.
Results from Monash and Logan hospital reviews will not be available until much later.
However, it is imperative that the discussions start across hospitals in Australia around better communication with parents from diverse backgrounds and that learnings are shared across the board.