Nasser hospital, Khan Yunis

Today, after 4 hours sleep, you head to work in the scrubs you wore yesterday and maybe the day before. You had slept fitfully, thankfully no nightmares. You look down at your hands and try remove the crud collected under fingernails.

Outside in the distance you can hear the heavy thump of artillery and the rapid staccato of machine guns. Overhead a rhythmic thump of helicopter blades. “Incoming” is a thought that comes to mind before you realise you last watches MASH 20 years ago. You can pick out the higher pitched noise of surveillance drone. Well not just surveillance as some also carry weapons, capable of being remotely fired from across the wall in an airconditioned room by someone who probably had a shower and decent breakfast.

Ahead, down the corridor you hear yells and cries. An explosion sounded very near, the building shook. Turning a corner corridor that leads to the emergency room, the noise increased. Patients, some of who you recognise from the previous day, lay on thin mattress covered with sheets, some stained with blood. Mother’, wives, fathers, husbands and children sit accompanying the injured.

Almost into the emergency room, there is another blast, more gunshots nearer. There is a hiss of water leaking from pipes, dust fills the air, panels hang from the ceiling the floor is dirty. Voices cry out for help. Someone lies unmoving next to broken window. Outside the window you see movement and flashes of light, sounds of gunshots. You duck instinctively. Your say to yourself “I wasn’t trained for this.”

from https://www.commondreams.org/tag/nasser-hospital

Another doctor spots you and yells to come over to a bed where two nurses are doing CPR. You see a missing leg. In your mind you know that without blood, an operating theatre, drugs that CPR will be futile but you join in but realise quickly, that it is indeed futile. Shaking your head, you look at a person nearby crying. “Ana asef”

Your day has begun again in a hospital under attack, a place that under international rules should be a sanctuary, a place of healing where suffering can be relieved, not inflicted. More explosions and gunfire. More noise.

This is a brief work of fiction but based on what is happening in Gaza to other doctors….

From

https://www.theguardian.com/world/2024/feb/15/israeli-troops-raid-nasser-hospital-southern-gaza

If you rather read the experience of doctors who are actually working in Gaza here is a link to two reports.

The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) strongly condemns the decision by Israeli forces to issue an evacuation order to thousands of displaced Palestinians who have sought safety from the conflict inside Nasser Hospital in Khan Younis.

https://www.doctorswithoutborders.org/latest/gaza-msf-condemns-israels-forced-evacuation-nasser-hospital

“On my last day, as I returned to the guest house where locals knew foreigners were staying, a young boy ran up and handed me a small gift. It was a rock from the beach, with an Arabic inscription written with a marker: “From Gaza, With Love, Despite the Pain.” 

https://www.latimes.com/opinion/story/2024-02-16/rafah-gaza-hospitals-surgery-israel-bombing-ground-offensive-children

In this video, Australian healthcare workers take you on a tour through the hospitals of Gaza. It’s devastating and unacceptable.

https://www.instagram.com/reel/C3cVL2iL03U/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==

Article 18

Civilian hospitals organized to give care to the wounded and sick, the infirm and maternity cases, may in no circumstances be the object of attack, but shall at all times be respected and protected by the Parties to the conflict. Article 18 of the Geneva Convention stipulates that a building designated as a civilian hospital cannot be the target of attack.  

_{from Wikipedia}

Imagine just for a moment living in a world were if you go to hospital with an injury and someone you think fits a profile a doctor walk up to you and blow your brains out, oh and anyone else in the room with you at the time. No judge, jury, just an executioner.

This is the basis of extrajudicial killing.

This is not a John le Carré or Tom Clancy work of fiction, it is the latest work of Israeli death squads. And it was not a doctor, thankfully, but a team of assassins disguised as a medical team who entered a hospital room and murdered three people. This is a violation of the rules of war. There was no court to judge the evidence just an assassin’s bullet.

This is not a new side to the conflict between Palestine and Israel. There is a long history of extrajudicial killing and assassinations that have blotted Israel’s veneer of civilised society. Probably the most famous were the peacemaker Count Folke Bernadotte. He was acclaimed as saving thousands of POWs from prison camps in WW2, including Australians. After the war he assisted in rescuing people, including Jews, from Nazi concentration camps. Yet in trying to settle conflict between the infant state of Israel and Arabs in 1948 he was murdered by Zionists with links to the Israeli government. In fact, Yitzhak Shamir reputedly played a role in planning the assassination; was never tried and later was elected as Prime Minister of Israel.

Many less notables have been murdered by Israeli death squads around the world. In Lillehammer, Norway, Ahmed Bouchikhi who had a passing resemblance (of Arab descent) to a Palestinian in being who was involved Black September, was murdered in front of his pregnant wife. Racial profiling gone wrong.

Amnesty International has documented an enormous number of extrajudicial killings of Palestinians by Israeli death squads. This article is from 2016 https://www.amnesty.org/en/latest/news/2016/09/israel-opt-pattern-of-unlawful-killings-reveals-shocking-disregard-for-human-life/ and 2022
https://www.amnesty.org/en/latest/news/2022/05/israel-opt-increase-in-unlawful-killings-and-other-crimes-highlights-urgent-need-to-end-israels-apartheid-against-palestinians/

Human Rights International is another source of information of extrajudicial killings.
https://www.hrw.org/news/2017/01/02/israel/palestine-some-officials-backing-shoot-kill

Its not difficult to find other stories doing a simple Google Search of reputable sources.

This is the life you live in an institutionalised racial segregation system. Where a man with an automatic weapon can enter a mosque and killing 29 and injuring about 150 Palestinians praying and be held up as a hero by segments of the Israeli society, including some members of Netanyahu’s government.
https://www.middleeasteye.net/news/israel-ben-gvir-baruch-goldstein-meir-kahane-memorial-martyrs-

Imagine an Australia were Brenton Tarrant is celebrated?

Similar weapons are being handed out to settlers and can be freely seen on images of the streets Israel.

Now, back to the latest extrajudicial killing. In this a man who was alleged to have tied to Hamas, is murdered in a hospital bed whilst receiving treatment for his injuries. Two others were with him at the time.

Imagine being part of the medical team that had cared for him?

The Israeli death squad were dressed in scrubs just like his health care team. Now how do you feel?

Imaging being a patient who now sees a nurse in scrubs providing care thinking is this person going to shoot me, what’s in that syringe….?

Imagine going to work in a Gaza hospital not knowing if a 2000 pound bomb is going to end your day?

Prior to the Israeli attack on Gaza, violence was a common problem in Palestinian hospitals as documented in this 2012 cross sectional study. The majority of respondents (80.4%) reported exposure to violence in the previous 12 months; 20.8% physical and 59.6% non-physical. The assailants were mostly the patients’ relatives or visitors, followed by the patients themselves, and co-workers. Since October, I am sure any sense of being able to control the violence in your workplace has been lost.

Thankfully in Australia, we don’t need entertain such extreme thoughts of “will I live or die by being at work”, but across the world violence against hospitals, doctors, nurses and the people that come for healing these thoughts maybe real. How is their mental health.

What side of history will you be on and what are you prepared to ignore?

Double standards?

The Australian Government has announced they will no longer fund state health department as they have heard that some employees may be antivaxxers.

An unlikely scenario but what is happening to Gazans dependent upon UNRWA just adds to their sense of collective punishment.

Since 1948, the UN agency for Palestinian refugees (UNRWA) has funded almost entirely by voluntary contributions from UN Member States. UNRWA also receives some funding from the Regular Budget of the United Nations, which is used mostly for international staffing costs.

So Israel has alleged that 12 UNWRA staff may have aided Hamas. UNWRA employs 13,000 to provide vital aid to Gazans who have driven from their destroyed homes by Israeli bombs, leaving dead relatives behind.

Philippe Lazzarini, UNRWA Commissioner-General from Ammna, Jordan has said, “The Israeli Authorities have provided UNRWA with information about the alleged involvement of several UNRWA employees in the horrific attacks on Israel on 7 October. To protect the Agency’s ability to deliver humanitarian assistance, I have taken the decision to immediately terminate the contracts of these staff members and launch an investigation in order to establish the truth without delay.  Any UNRWA employee who was involved in acts of terror will be held accountable, including through criminal prosecution. UNRWA reiterates its condemnation in the strongest possible terms of the abhorrent attacks of 7 October and calls for the immediate and unconditional release of all Israeli hostages and their safe return to their families. These shocking allegations come as more than 2 million people in Gaza depend on lifesaving assistance that the Agency has been providing since the war began. Anyone who betrays the fundamental values of the United Nations also betrays those whom we serve in Gaza, across the region and elsewhere around the world”.

Hamas has been the de facto authority in Gaza since shortly after Israel withdrew from the territory in 2005. It provides social services to Gazans, including health care, education and religious instruction. These roles gave forgotten about as it also has a military wing in conflict with Israel.

As many have said Palestine is not Hamas. Just as not all Israeli are engaged in the conflict in Gaza. For example, B’Tselem calls for a ceasefire. It calls out Israeli’s regime of apartheid and occupation and human rights violations. It strives future in which human rights, democracy, liberty and equality are ensured to all people, both Palestinian and Israeli

Netanyahu and his government has for year supported Hamas with a financial pipeline from Qatar, cynically to divide the Palestinian people. This has been highlighted in a number of articles such as these Times of Israel and NY Times.

Australia exported to Israel totaled $13m of “arms and ammunition”, over the past five years, including $2.3m in 2022. As Australia has announced a pause for UNWRA funding, why does the Australian Government continue to support Israel?

In the meantime Israel Defense Force has killed 26,000 Gazans and severely restricts any humanitarian aid into Gaza to the Rafah border crossing.

Update 17 March 2024

The Australian Government is reinstating funding to UNWRA.

https://www.afr.com/…/australia-ends-freeze-on-6m-for…

Meanwhile, the shadow home affairs minister wants Gazans to wait until the US builds its pier or scurry around hoping not to have aid dropped on their head. I also doubt Israeli school textbooks talk about any Palestinian ethnic cleansing and massacres in 1948. And, no Israelis are not taught to hate and dehumanise Palestians, no not at all. The death toll continues to climb – 31,490 as of 15 March.

Paterson repeats Israeli allegations about UNWRA

“My view is we shouldn’t tolerate a single Australian dollar going to a to potential terrorist. This is not the only accusation against them. There is a Hamas datacentre underneath their headquarters in Gaza, [getting] mains power from UNWRA, who admitted in the past their textbooks in UNWRA schools in Gaza had antisemitic [material] that promotes hatred against the Jewish people. Israel have been warning us for years about the behaviour of UNWRA and the warnings were ignored. And the employees participated then on the worst attack on Jewish people since the Holocaust.”

UNRWA has 13,000 staff; there were 12 people alleged by the Israeli government to have been involved in the 7 October attacks. UNRWA has admitted it fired those accused without investigating the claims as a pre-emptive measure in an example of “reverse due process”. Israel has also claimed one-in-ten UNWRA employees are Hamas supporters and called for the organisation to be dismantled. The Israeli government has been repeatedly asked to supply evidence to support its claims but has so far failed or refused to do so.

Rule 35

Directing an attack against a zone established to shelter the wounded, the sick and civilians from the effects of hostilities is prohibited.

I am a doctor, my wife a nurse & midwife, so I have a pretty selfish conflict of interest in sharing this post. I don’t want to be killed during my working life providing care for people who have come for help. In Mackay, that is going to be pretty unlikely. Although, recently a doctor in Nowra faced down a patient with a gun and an Adelaide doctor was bashed during a robbery at home (he later died from his injuries) this is not the usual narrative in Australia.

There are places in the world where a doctor, midwife, nurse or any healthcare profession may well face this narrative on a daily basis.

Although with a bias towards US interest risk, the Centre for Preventive Action hosts a website in which world conflicts are tracked. It aims to “inform the general public about threats to international peace and security by providing a reliable and regularly updated online source of information about ongoing conflicts.”

Today, I counted conflict on every continent bar Australia and Antarctica. For example, there is obviously Gaza and Ukraine which have been in the headlines recently. There has been a rise in conflict in Democratic Republic of Congo as the country went to elections last in 2023. Even though President Tshisekedi was returned there is concern about ongoing violence there. Civil wars affect Syria, Sudan and Yemen, Somalia just to name a few. Another website which lists countries in armed conflict is The Geneva Academy.

https://www.cfr.org/global-conflict-tracker#

In all of those conflicts doctors and nurses are called on to deal with injuries to civilians and in maybe even combatants. Hospitals provide a place to provide that care, open spaces, specialised equipment, medications, an operating room, an emergency department, a place where a team manages the patient. Providing medical, social and humanitarian care and simple things like food, water, blankets, protection from the weather. At the same time hospitals and health care facilities still need to deal with the usual medical care. I see 30 to 40 patients a day- none with bomb fragments or bullet wounds.

And because care may be provided to an opponent (real or perceived), doctors and nurses become a target. Or even if this world of “precision” targeting become collateral damage. Perversely, the destruction of hospital may be factored into some calculus of proportionality. Although difficult to predict the fragmentation pattern and range of a 2,000lb Mk 84 bomb is generally said that this weapon has a ‘lethal radius’ of up to 360m. The blast waves of such a weapon can create a very great concussive effect; affects humans up to 800 metres from the point of impact. Yet these weapons are used multiple times in civilian-dense regions like Gaza. Remember 2 million people live in Gaza; 41 km long up to 12 km wide. I can ride my push bike 41 km in under 2 hours. At ground level you can see almost 5 km.

During the Syrian Civil war, which I read is finally winding down, Amnesty International alleges that hospitals were targeted intentionally by both the Syrian government forces and their Russians supporters. In 2016, Amnesty International noted “The latest string of attacks on health facilities north of Aleppo appears to be part of a pattern of attacks on medics and hospitals, a strategy that has destroyed scores of medical facilities and killed hundreds of doctors and nurses since the start of the conflict.”

In 2015, during the last Afghan war, the US intentionally destroyed a Medicine San Frontier hospital in Kunduz killing 42 people. The US claimed the hospital was occupied by militia, the MSF say it was treating wounded militia along with civilians.

The International Health Law implications of attacking medical facilities are discussed in this paper.

The remains of Kunduz Hospital October 2015

In Yeman, hospitals have been destroyed by the US backed Saudi coalition. August 2016, a hospital supported by Medicine San Frontier was bombed Saudi airstrike in the northern town of Abs, Yemen. By placing themselves in conflict zones, MSF does seem to be dealing with damaged health infrastructure more than others.

Abs Hospital, Yeman

During the Rwanda Genocide hospitals and churches did not save victims of violence’s. In fact some would say that in the mistaken belief sanctuary, such institutions made it easy for the orgy of death to continue. For doctors in these hospital a stethoscope draped around a neck was not a free pass to life.

As reported in the BMJ, human right group allege in Destruction and Devastation: One Year of Russia’s Assault on Ukraine’s Health Care System, that there were an average of two attacks every day between 24 February and 31 December 2022. These included hospitals being bombed, medics being tortured, and ambulances being shot at. Russian troops occupied a hospital knowing that under Rule 35, the Ukrainians would not return fire. In this case the hospital is a often a big, expansive sturdy building with many things soldiers need to prosecute a war.

The remains of a children’s hospital, Mariupol March 2022

Destroying hospitals is a war crime pure and simple. It is a crime to use a hospital for military purposes, something that Hamas amongst other have been alleged to do. But that does not morally justify another aggressor targeting the hospital. They make that choice to drop that 2000 pound bomb knowing full well the consequences.

Palestinians wounded in the Israeli bombardment of the Gaza Strip receive treatment at the Nasser hospital in Khan Younis. Meanwhile, it is reported on 23 January 2024, Israeli troops had stormed Khair Hospital and detained the medical staff preventing them from doing their job.

Some of the examples mentioned about discuss targeting the infrastructure in which we work. Unfortunately in recent conflicts individuals have also been targeted. For example Dr Tetsu Nakamura from Japan. After qualifying as a doctor he moved to Pakistan in 1984 to treat patients with leprosy, then crossed into Afghanistan, where he opened his first clinic in a remote village in Nangarhar and established a NGO, Peace Japan Medical Services. Honorary Afghan citizenship was his reward for dedication to humanitarian projects. He was killed along with five others during an ambush on the outskirts of Jalalabad in December 2019 at the age of 73. Dr Egil Tynaes, a Norwegian doctor died also in Afghanistan in an ambush in June 2004. There are many more dedicated individuals whose stories can be found by searching Google, and many more whose death goes unnoticed outside of their community.

Killing doctors and nurses means that from that day that highly trained individual no longer is there to help keep their community healthy. I not putting myself on some sort of pedestal here as health also means access to fresh food, water, sanitation protection from the elements. But in the indiscriminate bombing we have seen in Gaza those things have also been taken away.

This confronting article published today by Aljazeera details better than I the impact the Israeli war on Gaza is having on health care. Would I choose to be a doctor there?

https://www.aljazeera.com/features/longform/2024/1/23/how-doctors-in-gaza-persevere-amid-israel-attacks

Dear Minister Wong

Honourable Penny Wong

Dear Minister

I am writing to you as an Australian doctor concerned about the dire humanitarian and healthcare crisis in Gaza. I am a signatory, to a petition initiated by Australian and New Zealand doctors for Palestine, which has garnered over 28,000 signatures urging Australia to support South Africa at the International Court of Justice.

As you are aware, the healthcare infrastructure in Gaza is compromised. Over 24,000 lives have been lost, and more than 50,000 severe injuries sustained within just three short months. In addition to deaths and injuries caused directly by weaponry; many more civilians are now dying from the lack of access to healthcare for chronic treatable health conditions. Basic medicines such as insulin, heart and asthma medications are not available. Some have now live in makeshift shelters with their homes shattered by bombs.

The latest data from the World Health Organization indicates that Israeli attacks have taken a massive toll on healthcare facilities, ambulances, and healthcare workers. 26 of 35 hospitals are not fully functional, only 6 ambulances remain to service the entire Gaza Strip, and 374 healthcare workers have been killed. Children are facing a threat to their lives due to diseases, malnutrition, and ongoing violent attack. There is a prospect of preventable deaths due to malnutrition, starvation, respiratory illnesses, and diarrhoeal diseases will soon outnumber the daily death toll from occupation forces.

According to multiple sources, as at December 28th 2023, 278 health care workers have been killed, including 104 physicians and several intergenerational medical families, 87 nurses and 87 paramedics. Further, more than 70 medical staff have been arrested and taken to unknown locations. The Head of Al Shifa Hospital, Dr Muhammad Abu Salmiya, arrested on November 22 with other health care workers, continues to be detained. The list of health care worker casualties is likely incomplete and continues to increase. In addition to the attacks on individual health professionals, there have been 364 attacks on Gaza health care facilities, including hospitals, primary health care facilities and 190 ambulances. Health care facilities and institutions that have been bombed, damaged or shut down include: Al Ahli Arab Hospital, Gaza only cancer Hospital, the Turkish Palestinian Friendship Hospital, Abdel Aziz Al-Rantizi Paediatric Hospital, Al Nasr Paediatric Hospital, Al Quds Hospital, The International Eye Hospital, The Psychiatric Hospital, Al Wafa Rehabilitation Hospital, the Al Wafa elderly’s care centre, Al Durrah Children’s Hospital (targeted with prohibited white phosphorus on October 12), the Indonesian Hospital, Shifa Hospital, two medical schools (the Islamic University of Gaza and Al Azhar University Medical School) as well as medical and dental students.

In addition, an MSF evacuation convoy, an outpatients burn unit in Gaza city, an MSF minibus, a Red Cross ambulance convoy and Palestine Red Crescent Society ambulance centre in Jabalya were attacked. Further, Palestine Red Crescent Society operations have been suspended owing to depletion of necessary supplies and reduced ability to evacuate patients. Of the remaining hospitals partially functioning, all are operating at more than double capacity in the face of critical deficiencies of fuel and other supplies. UN shelters are over-crowded, with outbreaks of diseases such as respiratory tract and skin infections, and diarrhoeal illnesses, on the background of starvation and lack of water and sanitation. This is a public health catastrophe. Even if the conflict ended today, without a massive humanitarian effort, these disease will continue to impact Gazans.

The psychological well-being of the children of Gaza is deeply compromised by fear, grief and lack of access to basic human needs. This surely will only lead to a new generation of young men and women who can be manipulated by terrorist organisations.

The blockade on basic human necessities and healthcare is part of the genocidal acts by the Israeli government as alleged by voice of South Africa.

I am praying that the International Court of Justice will take immediate action to address this humanitarian crisis, ensuring justice, protection of human rights, and the well-being of the vulnerable population in Gaza. The Australian petition’s substantial support reflects a national outcry for accountability and intervention. This is further emphasised by a global petition which has attracted over half a million signatures.

This appalling situation is matter of grave concern for myself as a healthcare professional. It can only start to be managed with an immediate ceasefire. In addition, political, non-lethal pressure should be brought for Hamas and Islamic Jahid to release back to the families all the remaining Israeli hostages as a step towards reconciliation.

When you visit Israel, I hope you voice will carry weight to end this conflict, press for hostage release, and push for free flow of aid and urgent work on food, water and shelter for Gazan civilians.

Thank you for your time

Yours faithfully

Dr Mark Raines

Mackay

16 January 2024

Genocide?

Is Israel inflicting genocide upon the Palestinians of Gaza?

Using the diagram below from the Holocaust Memorial Day Trust, you can see parallels. Listen to Israeli government ministers if you doubt this.

Israeli Defense Minister Yoav Gallant in October “We are fighting human animals and we act accordingly,”

“We are now rolling out the Gaza Nakba,” Avi Dichter, Israeli Agriculture Minister and member of the right-wing Likud party, said Saturday, in comments widely reported by Israeli media. “From an operational point of view, there is no way to wage a war — as the Israeli army seeks to do in Gaza — with masses between the tanks and the soldiers,” he said. Pressed on his use of the word “Nakba” to describe the situation in Gaza, he said again: “Gaza Nakba 2023. That’s how it’ll end.”

Israeli Heritage Minister Amihai Eliyahu sparked outcry after he suggested that dropping a nuclear bomb on the Gaza Strip was “one of the possibilities” in the current conflict. He was asked “Your expectation is that tomorrow morning we’d drop what amounts to some kind a nuclear bomb on all of Gaza, flattening them, eliminating everybody there…,” In reply, Eliyahu responded, “That’s one way. The second way is to work out what’s important to them, what scares them, what deters them… They’re not scared of death.”

Israeli Finance Minister Bezalel Smotrich, a prominent settler activist, raised alarm himself earlier this month after calling for the creation of “sterile” zones in the West Bank in a letter he sent to Netanyahu and Defense Minister Yoav Gallant that was shared with Israeli media. Such zones, he said, would block Palestinians from entering certain areas and bar them from harvesting olives close to Israeli settlements in the enclave.

Israeli Minister of National Security Itamar Ben Gvir advocating for the resettlement of Palestinians outside of Gaza. The war presents an “opportunity to concentrate on encouraging the migration of the residents of Gaza,” Ben Gvir told reporters and members of his far-right Otzma Yehudit party, calling such a policy “a correct, just, moral and humane solution.”

“We want to encourage willful emigration, and we need to find countries willing to take them in,” says Smotrich. He has gone on to be reported as saying “We need to encourage immigration from there. If there were 100,000-200,000 Arabs in the Strip and not two million, the whole conversation about the day after [the war] would be completely different,” he said. “They want to leave. They have been living in a ghetto for 75 years and are in need.”

So we have classification, discrimination, dehumanisation, the invasion of Gaza is certainly planned, and pro-Israeli media have certainly spread polarising propaganda, 22,000 out of 2 million Gazans have died, many more injured, and there are certainly lots of denial going on. Is this Genocide?

What follows are two commentaries which delve further into the case against Israel, including a case brought by South Africa against Israel to the International Court of Justice.

Finally, for those who think genocide is a numbers game alone please listen to this podcast from Let’s Talk Palestine.

https://open.spotify.com/episode/4XhEjTyLzPtnxj7emcnpyg?si=9c6c7ff26589483a

Editted with the Internal Court of Justice presentations.
https://youtu.be/0Q_zTb9dfGU?si=O-PL9YNqlua_-8t8
https://youtu.be/imn9daDE2dQ?si=8YAYjD8LqK0lafiq

True confessions…..

Ring block only works with one of these solutions.

“Ooh doctor that still hurts”

“I’ll give it another 10.5 seconds and try again”

“Ooh…..”

“Hmm”

I felt sick in the stomach.

I had made a mistake.

I had tried to pull off a toenail without anaesthetic on someone’s Grandma.

I thought she was being overly whingy putting in the block.

I hadn’t checked the ampoule label.

I thought how could I hide my mistake?

Who could I blame. The patient for talking so much and distracting me. The nurse who restocked the drugs.

She’ll think I’m a useless doctor and never trust me again I thought.

So taking a deep breath I took responsibility, confessed to why her toe hurt so much and offered to let someone else finish the job.

Graciously she let me finish the task with lignocaine not water for injection. It worked as expected.

Lesson learnt: read the bloody label and don’t just assume if it is in the lignocaine bin and it has blue writing on it it is lignocaine.

Being a Doctor on Social Media

In our community, doctors are in a group of people that are held up to a different standard than the rest of the community. I realised that a few years ago when I posted to Facebook a picture of myself holding up a dead feral cat that I had dispatched with an arrow. Someone commented “Doctors should not be killing animals” And I thought I was doing the environment a favour by taking a predator of native animals out of the picture. I wont republish that here!

from https://www.reddit.com/r/midjourney/comments/1781e03/visions_of_peace/

In Australia, Australian Health Practitioner Regulation Agency (AHPRA) works in partnership with the National Boards to ensure that Australia’s registered health practitioners are suitably trained, qualified and safe to practice. It also polices the standard of health practitioners and deals with complaints against medical practitioners for a variety of reason.

Recently, I gave up being a moderator of a group I had been a member of for almost 10 years because I felt posts which were related to the current conflict between Israel and Palestine were being removed without explanation to the members. I posted about censorship in the group which resulted in a a flurry of likes and conversation about censorship with support for my views. I never thought I was a whisteblower until someone thanked me for being so. The post received support from a variety of GPs, but then it was limited, the it was closed and then it was gone. I explained to the administrators of the group what I thought of this and got told off.

I think the rationale was a fear that any posts about Israel and Palestine may incur the wrath of AHPRA but this was never full explained to members of the groups at the time I resigned. As a moderator there had been an incomplete discussion of what to do. A group of over 10,000 Australian & New Zealand doctors will contain a broad representatives from our multicultural society and a comment may not always be taken as intended.

In the censored post there had been conversation between Australian who supported Palestine, those that supported Israel. those that explained being Jewish or Muslim in Australia they felt a threat. One GP explained how she was now feeling anxious about leaving her children in daycare. This saddens me immensely because generally Australia is a mostly tolerant society. Although, yes we have a small number of extremists on both side who cowardly express their hatred in graffiti and social media. I have never felt threatened by the colour of my skin or the shape of my nose, or whatever someone uses to highlight racial difference. I have however recall feel threatened because of my spectacles, my favoured mode of transport, a bicycle, but that’s about it.

AHPRA enforce a social media policy on all doctors in which we are told we should

• complying with confidentiality and privacy obligations 
• complying with your professional obligations as defined in your Board’s Code of conduct
• maintaining professional boundaries 
• communicating professionally and respectfully with or about patients, colleagues and employers, and 
• not presenting information that is false, misleading or deceptive, including advertising only claims that are supported by acceptable evidence.

There have been several articles warning about the perils of social media the medical media.

The Medical Board code of conduct, which sets out the expected professional standard of practice, acknowledges that doctors have a right to express their personal views but notes that the boundary between a doctor’s personal and public profile can be “blurred”.  

Recently, AHPRA sanctioned a doctor following a complaint that her social media post questioned some of the appalling actions of Hamas in Israel on October 7. The medial defense company I subscribe to warns to take care. From the AusDoc article

An Avant spokesperson said the Medical Board of Australia’s code of conduct recognised doctors’ right to express personal views but warned “the boundary between a doctor’s personal and public profile can be blurred”.  The medical defence organisation (MDO) pointed to sections of the code that urged doctors to recognise that “cultural differences may impact on the doctor–patient relationship and the delivery of health services”. It also specifically warned doctors against expressing “personal beliefs to your patients in ways that exploit their vulnerability or are likely to cause them distress”.

AHPRA is a potential weapon that can be used to threaten doctors, whether that was AHPRA’s intention or not. The fear of a vexatious complaint is real. Possibly, as much as the fear of sued for a medical mishap. As defined by AHPRA, “a vexatious notification (concern) is one without substance, made with an intent to cause distress, detriment or harassment to a practitioner named in the notification. Vexatious notifications can come from anyone including patients, members of the public and other practitioners”.
There are several examples of this type of complain having an impact on doctors. Here is one reported in the RACGP media.

The fear of an AHPRA sanction leads social media posts being censored and lead to my post on censorship being sanctioned. This is just one of the implications of the standards that we, as health professional are held to, different to plumbers, bricklayers and used care salesmen in Australia.

Maybe before considering to be a doctor, a young person should undergo a process of informed consent to understand they will be beholden to different rules in society?

Gaza 2023

Israel, renewing the stains of its foundation with the blood of Palestine

Sorry

I am proud to be part of the 41% of Australians who felt the status quo was not good enough.

For those who voted No how do you plan to make a difference now?

fbt