Published: 08 July 2015

 Ms FORREST (Murchison) - Mr President, it is important to speak to this bill.  It is substantial legislation.  It does not change many things.  It tidies up some things that needed to be for obvious reasons.  It is important to note that, as the Leader said, changes in improvements in managing public health continue at a fairly significant pace and that each day our knowledge, understanding, effective prevention and management of disease grows.

One of the areas addressed in this bill is testing for and managing patients with HIV.  I remember when HIV first became a health issue.  I was teaching sex education then and it was a really interesting time because there was a huge amount of fear about HIV.  It was considered a homosexual person's issue, and perhaps initially it was more focused in that community.  But it is not now an illness or a condition in any way limited to the homosexual population.  It is an even bigger risk for the heterosexual population because often they do not appreciate the risk and they do not necessarily take adequate precautions.  In many African nations, and other nations where it has been a problem, the women in those nations are often unfortunately infected by HIV through the actions of their husbands.  In a lot of these cultures, when women are pregnant their husbands go off and find their satisfaction elsewhere, then bring back the infection and illnesses to their wives subsequent to the birth, which may be okay for the first baby but it is not okay for the subsequent ones, because the real risk of HIV is to the unborn baby.


I am a bit out of touch with current practice in obstetrics as it has been a few years since I actively practised, but I believe the recommendation probably still is to do caesareans, rather than take the risk of a vaginal birth, though that varies.  The minimal intervention is the approach, such as not artificially rupturing membranes.  Then there is the issue of breastfeeding and the passage of HIV through breastmilk to the baby and the risk that can bring.  In these developing nations babies need to be breastfed because the risk to health is much greater by not breastfeeding them, so it becomes a balance of the greater risk to the baby's health and wellbeing.


We have learnt a lot along the way.  I am sure everyone in this Chamber would be old enough to remember the Grim Reaper advertisements.  That was the approach we took.  It was fear, it was unknown, and it was scary.


It is a serious illness and has a lifelong impact but it can be more managed now.  So it is appropriate that we do not have specific legislation for an illness that should be treated much the same as other illnesses, being aware that they can have lifelong impacts, they can be transmitted from person to person but that HIV is not alone in that.


There are many others.  In many ways it is like having the appropriate legislation in the public health framework that picks up all of these areas and does not single out ones that seem to be different for whatever reason.


I accept that when that happened it was an unknown, it was scary, and we did not know a lot about it.  It is good to see this is being contemporised to make it relevant to circumstances we find ourselves in now, with the knowledge that we now have about HIV.  I remember wondering at the time why we had such a different approach to this when there were other illnesses that potentially were also quite harmful and passed on through sexual activity.  It seems to be a bit of a taboo area if there is sex involved because then we have to have it treated differently.  Thankfully, we have moved on from that.  It is not just transmitted through sexual activity - needlestick injuries and other use of shared needles, and that sort of thing, also have an impact.


The other point is the approved health care work.  I was an Approved Health Care Worker.  I went through that process.  Again, it was singling people out so you have the capacity to go through quite an elaborate framework.  You could not test anyone for HIV before they had pre‑test counselling.  They had to have the counselling first-up to prepare them for the possibility they could be positive or negative.  But even to get the result they had to come back.  Even when they were negative you had to counsel them after that because they could be positive later if they were not careful.  It was an interesting approach.  It was almost a scare campaign, and we focused on HIV to the exclusion of some other illnesses.  I have not renewed my Approved Health Care Worker certificate for some time now and I will no longer need to.


The other matter that has been picked up in this legislation is the state's needle and syringe program.  I fully agree with the comments of the Leader, that there has been enormous public health benefit from this longstanding program.  It is a relatively small investment with a positive economic impact and health outcome.


I still believe that education is a very important part of this.  You cannot just have this needle exchange or needle and syringe program, but not continue to educate the public about it, particularly about safe disposal.  I am sure all of us are aware that whenever there is a needle and syringe found on a beach, it is often scary because it is in sand and people can step on it without seeing it.  If it is on a hard surface, it is easier to see.  The probability of catching HIV from a needlestick injury from a syringe or a needle found on the beach is very low.  The HIV virus does not live very long outside the human body, whereas hepatitis C, for example, lives a lot longer and your changes of catching hepatitis C are much greater.  People are much more aware of that now, but again public education continues to be very important.  It is great to have these programs in place but we need to ensure that the public are well educated and informed in this area.


The amendment to the laws relating to the distribution of unused equipment among injecting drug users being eased is relevant too, as well as the disposal of used needles.  If someone is actually on their way to dispose of it, you do not want them to be accused of any other crime.  That makes no sense at all.  You want them to dispose of it accurately and correctly, and again public education is the key.


Another important area is the Cervical Cancer Prevention Program.  I believe this has been a very successful program.  I am not sure of the actual numbers of women who have signed up to it.  It is probably in the budget papers somewhere; I did not have time to look at it.  Without a reminder, I would forget.  It is not the most pleasant procedure to have done in your day‑to‑day life, even though I am a midwife and had experience of all sorts of activities in that area.  To go and have a Pap smear yourself is not something you line up for with great joy and delight - well, I do not, personally.


When you get the reminder, it reminds you to have this screening test done and it is no big deal.  The great thing now is that - particularly in my doctor's surgery, and there are probably many others - they have a nurse practitioner trained to do it, and naturally that is much better as nurses in these roles are predominantly female.  They do this a lot so they are actually better skilled at doing it.  That has been a very positive thing as well.


I go to a practice where there is a male and a female GP, and I see whoever is available at the time.  My male GP refuses to do it anyway.  He says, 'You can go and see Fiona, she will do it'.


Mr Valentine - One expects that will reduce over time with the immunisations that are available now, is that right?


Ms FORREST - The need for Pap smears still exists.


Mr Valentine - Yes, but maybe not so frequently after the immunisations catch up.


Ms FORREST - Do you mean with the HPV vaccine?


Mr Valentine - No, cervical cancer.


Ms FORREST - Yes.  I do not believe that is the case.  I believe Pap smears will still be required biennially but the Leader may be able to address that in her reply.  It does reduce some forms of cervical cancer.


Mr Valentine - Only some?


Ms FORREST - Yes, as I understand it.  I am a little bit out of touch in this area, so I rely on the expert advice, the Leader's advisers perhaps, on that.


It is also appropriate in part 3 of the bill to apply some of these emergency framework provisions.  It was interesting to note that the public health emergency management provisions will be enhanced by the introduction of a warrant framework, so that under this framework the magistrate may make orders in relation to a person if satisfied it is necessary to manage a threat or likely threat to public health.


It is also worth noting that to date the Director of Public Health has not used the existing warrant provisions relating to non-emergency periods.  Generally, people are willing to take action as recommended by the authorities because we do not want to be the ones negatively impacted either.  But it is important to have that provision when people may not be willing to respond appropriately.  Sometimes people may not have the capacity to do that - they may have a severe mental illness that makes it difficult for them to understand the direction or the requirement to behave in a certain way, or to remove themselves from contact with others, or whatever it is.


We only have to look at what happened in parts of the world where Ebola was a problem.  If you have a situation like that where people do not behave appropriately, you can have rapid spread of very serious illness.  We hope we never see that here but the reality is, it could come here, with world travel the way it is.  We need these provisions to ensure there are measures in place that can be quickly implemented if the need arises.


There was an interesting item posted on Facebook about vaccinations.  There is a photograph of a young woman between 14 and 16-years-old - it is hard to tell - who appears to be dead, sitting in a corner with a needle in her arm.  It is an anti-vaccination advertisement, saying that the first needle she had was a vaccination.  I find it a really provocative and quite ill-informed approach to vaccination.  I do not know the background to it, but I have seen it a few times recently.  These sorts of things get out into the public arena and make people fearful of vaccination.


As a nurse, I have looked after babies with whooping cough.  I was a student at the time, in my second year, and for five or six days in a row I was looking after these three babies - one was four‑months‑old, one was five‑months‑old and one was six‑months‑old - all with whooping cough.  None of them had been fully vaccinated by that stage because they were too young to be fully vaccinated, but obviously they caught it from someone who was not vaccinated.  I went from baby to baby to baby, sucking them out so they did not die.  It was constant.  One would start gurgling and going blue, and you would suck that one out, and the next one would start.  It was an horrendous experience.  They all survived, thankfully, but even though I was vaccinated I think I got a form of whooping cough afterwards.  I got this terrible cough, with a real whoop at the end, some time afterwards.  No matter how good your barrier nursing is, when you are in constant contact in that way, you are totally immersed in it.


I know there are people who have a genuine reason for not vaccinating their child - they may have a clear indication of an allergy that would mean the child's life could be threatened by receiving a vaccination, but that is rare.  We need to have these public education messages out there about vaccination because until you get the herd vaccine approach, you have not won the battle.


We only have to look at the amazing work Rotary International has been doing with polio.  I am not sure if we have eradicated it, but it must be getting close.  The Leader would know more about that with her involvement in Rotary.  If we want to get rid of some of these illnesses we have to take them seriously and put out factual information.  These sorts of advertisements on Facebook make people fearful and do not present the true picture.


The other area is drinking water safety.  The amendments appear to be sensible in that regard.


Overall I support the bill.  Some aspects of it are particularly timely and appropriate.  I spoke to the member for Elwick - who is not in the Chamber at the moment - about this a couple of days ago.  I suggested it might be preferable not to have these issues all presented at once, so we have more time to look at individual things like water, and HIV and cervical cancer screening.  It has all been dropped on us at once, with a relatively short time frame to consider several issues.


I do not have a huge issue with it, but it would be easier if we had it broken down into the separate areas.  I suppose it takes time to organise these things to be done, and maybe it is easier for the department this way.


I support the bill.


[11.50 a.m.]

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