Federation Chamber - BILLS - Treatment Benefits (Special Access) Bill 2019, Treatment Benefits (Special Access) (Consequential Amendments and Transitional Provisions) Bill 2019 - Second Reading

20 February 2019

I thank the member for Murray for his encouraging words. I too rise to support this very important bill, the Treatment Benefits (Special Access) Bill 2019. It's been nearly 20 years since the plight of members of the civilian surgical teams who served in Vietnam was raised by a civilian nurse who became seriously ill with a condition associated with exposure to herbicides and identified in studies documenting the incidence of cancer in Vietnam veterans.

In 1999, after her claim for benefits under the Veterans' Entitlements Act 1986 was rejected, the matter went before the Veterans' Review Board. The board affirmed the decision; however, it expressed regret that the nurse was not able to be compensated under the act and identified an anomaly whereby the act makes a distinction between different conflicts when it comes to Commonwealth employees performing special missions outside Australia. It identified two options: an amendment to the act or a claim to Comcare.

Despite a positive finding from an independent review into service anomalies in February 2000, recommending that members of the civilian, surgical and medical teams operating in Vietnam be deemed as performing qualifying service for repat benefits, the government refused to acknowledge the nurses' claims on the basis they were not attached to the ADF. Comcare, the Commonwealth workers' compensation scheme, was the only option for those nurses who developed illnesses and injury as a result of their service in Vietnam.

For a number of reasons, this scheme is not suited to deal with war-related injury and illness. Despite the processes put in place to facilitate claims through Comcare, nurses were still disadvantaged in comparison to the veterans community. Fundamentally, because it's a workers' comp scheme, it is not designed to deal with the complexities arising from injuries incurred as a result of the trauma of war. This is precisely why there is a different system for veterans.

In 1962, the Australian government was asked by the USA to supply an army training team as well as surgical services and medical care to the South Vietnamese people and the large refugee population from North Vietnam. Both groups were part of the contingency planning of the bipartisan SEATO—the Southeast Asia Treaty Organization—by the Department of External Affairs and the Department of Defence, as was the major commitment of ground troops in 1965. 

The SEATO civilian surgical teams were the first official Australian medical surgical support group sent into South Vietnam. The other military services did not arrive until 1966. The civilian team was also the last Australian medical surgical group to leave. Their overall time in Vietnam ranged from October 1964 to New Year's Eve 1972. Approximately 450 civilian nurses, doctors and other allied health personnel served on these teams. This represents the largest group of Australian doctors and nurses to serve in South Vietnam during the war.

SEATO nurses were sent to Vietnam by the Australian government to serve in civilian surgical and medical teams as part of Australia's strategic and military commitment to the Vietnam War. Many of the nurses have suffered the same illnesses and medical conditions as Vietnam veterans and that are similarly war related. Conditions include post-traumatic stress, other anxiety disorders, non-Hodgkin's lymphoma, cancers and other immune system disorders. The claims set out conditions that were not all covered by Comcare.

One wonderful nurse was Dot Angell. She was a free-spirited 20-something when she answered the Australian government's call for civilian volunteers to head over to Vietnam in the thick of war and serve in the relief effort. It was 1967 and Dot became part of the Alfred Hospital civilian, surgical and medical team which would spend several months at the Bien Hoa Provincial Hospital, tending to anyone and everyone who walked through the door. The project was run under the umbrella of SEATO, with more than 450 nurses and doctors signing up to the cause, as I said before. The civilian teams had begun journeying to Vietnam in 1964. Dot said:

Nobody said anything to us. Nobody told us what it would be like. Being young and having just got back from three and a half years overseas and it being the Swinging Sixties I was young and foolish and decided it would be an adventure so I volunteered.

Dot recalls working around the clock in a race to treat the scores of patients caught in the crossfire of war:

We treated anybody who came through the gates at the hospital, whether they were friend or foe. We were dealing with war injuries. We were dealing with traffic accidents because Bien Hoa was a refugee town and packed to capacity. We also dealt with illnesses, some of which we had never seen before, such as plague, typhoid, and cholera.

She said that she had vivid memories of one two-year-old who was brought to them by his sisters, who were aged seven and 10. The parents were nowhere to be seen, presumed dead. The child weighed less than 50 per cent of the normal weight for his age. She remembered a six-year-old in the same condition, who was brought as a last resort by his mother, who was very frightened because the VC had spread a rumour that the Australian medical teams castrated little boys.

Tuberculosis, infestation with intestinal parasites, leprosy and malaria had always been major causes of morbidity in Vietnam, but by 1967, with the overcrowding and squalid conditions, bubonic plague had spread to 24 of the 41 provinces of South Vietnam. Cholera was also on the rise and there was a possibility of a widespread epidemic. These nurses and doctors worked amongst it all.

The aims of the surgical team were to provide a general surgical/medical service of quality for the South Vietnamese; to teach, mainly by example, new surgical techniques and procedures; and to establish mutual goodwill—to establish a relationship of confidence and trust with the local people. The nurses from Bien Hoa are still very proud of the school of nursing that has a bachelor degree that exists today in that country.

To sum up the situation in which they found themselves whilst working in isolation with the civilian population, they bore witness to:

… the broken men, women and children; the villages destroyed; fields turned fallow and poisoned; cities where the rats found a better life than humans; epidemic diseases moving remorselessly with the tide of war; chronic diseases striking down the homeless, the undernourished and the starving … and over it all was an aura of ceaseless battle. In South Vietnam for the dazed, bewildered people, harassed by Vietcong, burned and burned again by American Napalm, uprooted from their thatched huts, herded from one refugee camp to another … there was no escape, for around them endlessly churned the vast technology of war, which had been let loose on their country.

However, each civilian surgical team was able to create a small island of sanity, security and care in the chaotic wilderness of the war zone. Dot Angell said:

We did not notice who it was who had fired the bullet, thrown the grenade, set the booby traps or released the napalm; what did have meaning for us was the burned or mutilated flesh, and the familial destruction and degradation which had been brought about by the war …

It was not our task to accuse, label or lay blame, our task was to diagnose, to operate, to care, comfort and treat; to inject and transfuse, when we had the equipment, and let others ask the questions. Our medical and nursing skills were to be offered to all who came through the gates of each hospital—friend or foe.

Dot Angell stands here before us today—she is still alive—but she is very sad for the approximately one-third of the SEATO nurses who have died. Dot was part of the last of the Alfred squads to head to Vietnam. Her crew handed over the reins to a unit from South Australia. When she returned home she had to go back to 'business as usual'. Decades later, while undertaking a PhD and interviewing a handful of civilian nurses who served in Vietnam, Dot suddenly realised that many of them were experiencing the same health conditions suffered by military forces, such as cancer and post-traumatic stress. This led Dot to establish a special interest group with the Australian Nursing Federation, of which I was very proud to be a member and, in fact, secretary.

In 1998 she embarked on an unwavering campaign demanding recognition for civilian nurses who served in Vietnam, and claims to the same health entitlements accessed by the military under the Veterans' Entitlements Act. Dot and many like her are adamant that the toll of Vietnam remains profound, with many nurses suffering cancers, including lung, bowel and breast cancer, as well as nightmares and flashbacks associated with PTSD.

Almost two decades on from attempting to seek compensation from the government, the battle for Medicare and entitlements is over. In the early 2000s, a handful of government reviews—chiefly the inquiry conducted by Major General RF Mohr—found that civilian teams were suffering higher rates of illnesses than in the general community and had performed services that should qualify them for repatriation benefits.

Dot quipped bluntly to me: 'I think the government's just hoping we'll all die out.' Dot—who suffers from two autoimmune disorders and PTSD, which she attributes squarely to her time in Vietnam—and the close-knit group of civilian nurses remain steadfast in their commitment. She says that the most important thing is that it should never happen again.

The Australian Nursing and Midwifery Federation has backed the nurses' plight since the campaign began and says it will continue to support the nurses. 'These brave nurses,' said Lee Thomas, the general secretary, in 2016, 'went above and beyond to work in demanding conditions in a relief effort assembled by the Australian government. Their service deserves full entitlements, and anything less is a slap in the face.'

There are other nurses—like Helen, who has suffered from cancer of the bowel and autoimmune problems, and believes Vietnam is the missing link. Many of them enjoy gathering on Anzac Day to share stories. Helen specifically says she has no regrets, and she remembers the Vietnamese people she met that fill her heart with warmth and joy all these years later: 'I often wonder where they are. They were very special to us.'

The unwavering fight for recognition was reignited by a petition presented to the House of Reps calling for gold cards to be granted to all surviving Australian nurses, doctors, physios, radiographers and lab technicians who served as part of the civilian teams from 1964 to 1972. Dot said, in a very special speech last year at the Shrine of Remembrance in Melbourne:

Today brings back memories of the stoicism and friendliness of the Vietnamese people and the collegiality or 'mateship' between the team members with whom I worked and lived, in what could only be described as the most chaotic and primitive conditions.

She said:

I stand here before you as one of the survivors for approximately one third of us have died. Like you we honour those who have died but we will continue to fight for those who live and suffer.

Today, to Dot and Helen and all the nurses and all the civilians who served in those civilian teams in Vietnam under the SEATO arrangements: thank you. We thank you from the bottom of our hearts for what you did, for your service and your sacrifice. We recognise what you did, and we are very pleased to say that, at last, you have the justice you deserve.