I would like to take this opportunity to share some light into the problems that International Medical Graduates sometimes face in Australia. IMG’s sacrifice a lot to leave their home countries and relocate to a foreign land. They provide essential healthcare to a lot of underserved areas in Australia. Although Dr Sofocado and his family have now been granted permanent residency, he is still crusading for changes to Australian migration laws to give the chance to a lot of doctors who have wholeheartedly served otherwise underserved areas of Australia.
I am including the email of Dr Cesar Sofocado to the current ADTOA chair, Dr Viney Joshi to illustrate his plight (With explicit permission from Dr Sofocado) and to get support for his crusade.
From: Cesar Sofocado <email@example.com>
Sent: Mon, 25 April, 2011 11:28:40 PM
Subject: May I ask for a Letter of Support or Any Assistance to my Family’s Request to the Hon Immigration Minister Chris Bowen for Humanitarian Consideration and Compassion for my Terminally ill Wife?
Re: Compassion to the family of Dr. Cesar Sofocado, whose wife Mary is terminally ill with secondary breast cancer (advanced)
Approval of the family’s permanent residency visa application based On Humanitarian and Compassionate Grounds
Divorce sick wife, doctor told
Dear Dr Viney Joshi,
Good morning Dr Viney Joshi!
First, I want to thank you for giving me the opportunity to share my family’s experience, especially of my wife, concerning BREAST CANCER which spread to her BRAIN and Lungs! We know that you are very busy and we really appreciate for giving a little of your precious time and attention to our humble request. I am an Overseas Trained Doctor ( Philippines ) – GP, working and providing medical services to the rural and remote areas of Western Australia , for almost six years now.
May I ask your help for a Letter of Support or Any Assistance to my Family’s request to the Hon Immigration Minister Chris Bowen for Humanitarian Consideration and Compassion for my terminally ill wife?
In 2005, my family arrived in Perth on Temporary Visa (Subclass 422, Medical Doctor) upon satisfying all conditions including health requirements. I served as Hospital Medical Officer in regional towns of Geraldton ( Geraldton Regional Hospital , WA ), and as a General Practitioner at Karratha (Karratha Medical Centre), Dampier (Dampier Medical Centre), and Dalyellup-Bunbury (Wishing Well Medical Clinic). Currently, I’m a GP here in Ellenbrook Medical Centre.
When my wife Mary was still healthy, she studied in TAFE-WA Central West Geraldton and TAFE-WA Pilbara. She worked in Early Learning Centre and Crèche, caring for babies and children.
In 2008, we applied for Independent Skilled Migrant Visa (Subclass 175) hoping to acquire permanent residency. Unfortunately, while in waiting for almost two years from DIAC’s (Dept of Immigration And Citizenship) response, Mary got suddenly ill and unexpectedly developed breast cancer which spread to her brain. She had undergone three major operations due to a malignant breast cancer and a brain tumour here in WA. She was also further diagnosed with lung cancer (which actually “missed” by her specialist) and was advised to undergo another Lung operation and radiation and chemotherapy.
As my wife’s health deteriorates her dream of our family’s residing permanently in Australia becomes blurred and dim. Although DIAC has full knowledge of Mary’s condition we were still advice to apply for W.A State Sponsorship Skilled Sponsored (Migrant) Visa (Subclass176). This application was later supported by Hon. Judi Moylan, MP and Hon. Frank Alban, MLA.
My family, especially my dying wife is not asking much from the Australian government. We just want a little recognition of my family’s contribution (thru me and my wife’s work and active participation in the church and community) to the rural & remote areas of WA, and humanitarian consideration and compassion to my terminally ill wife (41 y/o). It’s not my wife’s fault to have this advanced breast cancer! Nobody wants to have cancer! But this was the reason the DIAC is keep on pounding on my family’s minds (my wife, my two young daughters, and me)! And the Immigration Case Officer is using this Breast Cancer of my wife to reject our permanent residency visa, as a “gift” for our almost 6 years of service here in WA.
Her Excellency Ms Quentin Bryce AC, Governor-General of the Commonwealth of Australia, said in one of her speeches: “Every one of us is connected by it and to it in some way (breast cancer). Unlike you, I have not suffered frombreast cancer, but I have observed again and again its force and its devastation, something of what it means to be a woman – her family, our community”. Her Excellency emphasized that: “Women living with breast cancer are the inspiration! They fight their individual battles, quietly, patiently, but with the utmost determination and courage and the support of their families and friends. May their voices continue to be heard!”
As you can see Dr Viney Joshi, our case is unique in the sense that there is some form of “urgency” on the basis of my wife’s terminal illness. Unlike other visa applications refused due to medical conditions, wherein the applicants had the luxury of time and resources to wait the long process of appealing to the Migration Review Tribunal, because of Mary’s terminal cancer, we don’t have that time and much resource.
Another issue that I want the well-respected Dr Viney Joshi to be aware of, were the mistakes (which the immigration called as “miscommunications”) made by the Case Officers handling our application. I’m looking on another angle wherein the Immigration Case Officer 1 ( Ala– ) made a mistake of giving me an option of Visa 176 State Sponsorship. Because I trusted the Case Officer 1 ( Ala– ) of the Dept of Immigration and Citizenship and I believed that she’s ( Ala– ) an expert on her field, I followed her advice and applied for the Visa 176. I was granted the Western Australia State Sponsorship, and we’re told to proceed with our medical requirements by the new Case Officer 2 (And–). I am not aware that the Visa 176 advised to me by the Case Officer 1 ( Ala– ) has “no health waiver”, meaning we cannot appeal. I am not an expert in Immigration law. Case Officers of the Immigration of Australia are highly regarded as an expert with immigration rules and, they have the “power” to accept or reject the applicants. From the very beginning, our Case Officer 1 ( Ala– ) was aware of my wife’s medical condition. And now we’ve done everything, the new Case Officer (And–) handling our applications told me already that he’s (And–) going to reject our permanent residency visa application because of my wife’s medical condition and we cannot appeal for that because the Visa 176 we applied has “no health waiver!” Accordingly, the Case Officer 2 (DIAC) will approve only our Permanent Residency visa if my wife is already DEAD! Or if we are DIVORCED! Or if we are LEGALLY SEPARATED!
In my humble opinion, the Case Officer 1 ( Ala– ) gave us a “wrong information” and “misled” me and my family to apply for VISA 176 with no health waiver. This “miscommunication” (as called by the Immigration) will result to the rejection of our application according to Case Officer 2 (And–), with NO chance to appeal! This “miscommunications” made by DIAC’s own Case Officer “buried my family’s future” deeper into the ground. We are already down and injured because of the impact of Stage 4 advanced breast cancer to my wife and family! And this rejection will be no less than a Death sentence to my terminally ill wife, and my family! We feel that our already devastated family, especially my beloved wife, and after our share of work and contribution to the “Areas of Need” of Western Australia , is being treated unjustly and unfairly!
Our beloved Dr Viney Joshi my wife, my two young daughters and me, are down on our knees, begging and humbly pleading for your support and assistance in regards to our appeal with the Immigration Minister. Please, do help us! Thank you so much.
SOFOCADO FAMILY (Dr Cesar, Mary, Sofia, Kyla)
Home Address: 18 Heathland Terrace,
Ellenbrook WA 6069
H: 08 92973914
Our heartfelt thanks to the supports and pledges of the following:
“Dr Sofocado has provided so much to our society over the last few years- I believe it is only fair and just that he and his family are supported through this incredibly difficult time. They should not have to spend what little time may be remaining on fighting! Please let them live this time together, in peace.”
BA (Hons) Psychology, MAPS
“Mary (Stella) has shown to be an exceptionally talented child care assistant who always strives for best practice. Mary (Stella) is a very approachable, friendly and creative person and she has a genuine interest in the care and education of young children”
Pilbara TAFE Creche
“Due to the fact that his wife is terminally ill with breast and brain cancer, I would urge to consider Dr Sofocado’s plea for a permanent visa on compassionate grounds. I believe we owe this much to Dr Sofocado as the community of Western Australia had benefited from his medical services.”
Dr Alan Eggleston
Senator for Western Australia
“On both compassionate and practical grounds, I believe the Doctor and his family demonstrate a solid case for support and would ask that you carefully review the full merits of this case before you.”
Maria Vamvakinou MP
Federal Member for Calwell
“On compassionate grounds it would be clearly create a greater upheaval and cause further trauma to this family under the circumstance to have to leave the country with their two young children, From a practical point of view it would be tragic loss of a doctor who is now established in an area of increasing need.”
Judi Moylan MP
Member for Pearce
“Dr Sofocado and his wife have contributed actively to their communities. I believe that this family would be model citizens.”
Frank Alban MLA
Member for Swan Hills
“I am seeking compassionate consideration to grant the permanent visa application of Dr Cesar for the welfare of the whole family and especially for their two daughters. These children have grown with an Australian identity having experienced the Australian way of life in their early childhood years.”
Most Rev. Justin Bianchini, DD: Bishop, Catholic Diocese of Geraldton
Fr Maurizio Pettena CS: National Director, Australian Catholic Migrant and Refugee Office, Australian Catholic Bishop Conference
Fr Gerard Totanes: St Francis Xavier Cathedral, Geraldton
Fr Steven Casey: Parish Priest, Karratha/ Dampier WA
“I ask for your fresh consideration on the matter as a point of urgency in the light of humanitarian and compassionate grounds with what the family has been and continue to go through, but also from the point of view of what this family can continue to add to our communities if allowed to stay.”
Graham R Fabian
Sun City Christian Centre Geraldton
“It would be a shame if Mary’s illness results in their application being rejected as it would be very traumatic for the family to leave the country. It would also result in the unnecessary loss of a medical doctor who has been serving the Australian community for over five years, at a time when there is still a shortage of medical practitioners.”
Ramdas Sankaran: Executive Director, Multicultural Services Centre of Western Australia Inc
“Urgently, we are concerned on how to alleviate the plight of the Sofocado family by supporting the visa application already filed at DIAC. Dear Minister, we appeal to your compassion for the family while Mary is still alive. No one can prolong her precious life but your favourable action will surely make her last days less painful. Your act of compassion will be a lasting legacy not only to her two daughters but to all Filipino-Australian families and supporters.”
George Kotsakis: Chairperson, Migrante-Australia
Marino Salinas : President, Filipino Australian Club of Perth
Dante C. Maribbay,CD: President, Damayang Filipino Inc.
Noel Chicote: President, Filipino Australian Sports Association
“To deny the family of permanent residency will be very inhumane as they have served in the caring and wellbeing of fellow Australians and formed strong roots in Australia . It will be devastating enough for the girls to lose their mum at such an early and impressionable age and then to be told that they have to leave the country where they had dreams of building their future.”
Dr Amarjit Singh & Family
“Cesar & Mary has done Australia a very special service and I believe that we should be very grateful for that. Please let Mary spend her remaining days in Australia (which the Sofocado family considered as home) peacefully surrounded by her precious family and her loving friends!
“They’ve spent almost 6 years of their lives here in Australia and no doubt that they’ve embraced the system whole heartedly. The family had started a new home and look forward for a brighter future. We believed that they need a chance to be heard and be helped in whatever deemed possible for humanitarian reason as Mary’s agony should be appeased and serenity should foster for greater good.”
Dr Garry Fajardo & Family
Religious groups/organizations, private and community organizations, Individual patients/families and friends, in WA and other Australian states
AN OPEN LETTER TO NICOLA ROXON
Dear Ms. Roxon,
January 26th, 2010 was my final Australia Day as a non-citizen. After completing the mandatory three years of permanent residency, I shall be taking the first available opportunity to become a fully fledged member of this great country. My family and I love it here and would live nowhere else.
Australia is a fine democracy with a proud history, but there is an anachronism that remains – one that does not befit an egalitarian society in 2010.
It is a small piece of legislation that has adversely affected many thousands of doctors and their families directly. Its inception and perpetuation has been allowed through the acquiescent silence of scores of thousands of my own peers. When the adverse affect of this legislation on rural and remote communities is taken into account, the total number of people affected reaches into the millions.
More than this, the fact that this inequality is enshrined in the very law-of-the-land, reflects Australia in a poor light internationally.
In a week of monumental healthcare reform, I wish to take this opportunity to publicly convey my feelings regarding the situation currently faced by overseas trained doctors (OTDs).
As is widely known, the previous government introduced s19AB of the Health Insurance Act in order to provide a quick solution to the lack of doctors serving regional Australia. Its effect is to limit medical practise to designated ‘districts of workforce shortage’ for up to ten years – the so-called ‘ten year moratorium’. Many thousands of doctors and their families have been forced to relocate to rural and remote areas in order to make a living.
After thirteen years of operation, it is now abundantly clear that the policy has failed.
Three major medical professional bodies (RDAA, RACGP & AMA) have made recent statements removing their support for the policy. Your own foreword to the Report on the Audit of Health Workforce in Rural and Regional Australia, (April 2008) notes its deficiencies.
There is huge dismay in several quarters that this policy was ever put in place. Imagine how much better served the regional populations would have been if the huge domestic medical workforce had been tapped into in 1997 and beyond, rather than the relatively small – and sometimes ill prepared – imported foreign medical workforce.
If the pragmatic argument that 19AB has failed in its intended purpose is not sufficient, I would like to present a more compelling reason for cessation of this policy, as well as a proposal for replacing it.
19AB should be abandoned because it is discriminatory. Simple.
If you replaced ‘foreign-born’ with ‘black’ or ‘female’ or ‘Muslim’ the law would be unconscionable. It would be ‘racism’, ‘sexism’ or outright religious bigotry. But it is as much an accident of birth that I am English as it would be if I were black (though the latter may have surprised my parents somewhat more than the former). Just because there isn’t an ‘-ism’ for the form of discrimination that divides groups based on place of birth alone, does not reduce its discriminatory impact.
“But,” successive governments have said, “it isn’t where you were born, but where you trained to which 19AB pertains.”
1) Foreign born medical students in Australian universities are subject to the very same moratorium restrictions upon qualifying. They trained here – the same as all their peers. But they were not born here. This rather gives the lie to the premise that it is the place of training rather than place of birth that counts.
2) The fact that I attained my medical qualification in London was obviously a direct consequence of having been born and raised in London. It would be quite unreasonable to have expected me to undertake my undergraduate studies in Australia. I believe that it is similarly unreasonable to restrict my practise now for not having done so.
Actually, the issue of foreign students is quite topical currently. Officials from the Indian Government have advised their citizens not to study in Australia due to racism. This is pertinent and I would like to return to the issue later.
So what other objections might the Government raise to my argument that this is discrimination?
“The law doesn’t stop you practising, merely restricts your patients from claiming Medicare rebates for your service.”
True. But the appropriate rebuttal comes from case law, itself stemming from Australia’s own Racial Discrimination Act, 1975.
It is the ‘effect’ of the law – not its specific wording – that is of importance. This has been repeatedly demonstrated in Bropho vs. Western Australia, Gerhardy v Brown, Mabo v Queensland [no 1] & Purvis v New South Wales [Department of Education & Training].
The effect, as all medical practitioners know, is that if a patient is unable to access Medicare rebates for ones service, there will be a very severe restriction on ones ability to practise – to the extent where it may be impossible to generate an income at all.
“You knew what you were getting into before you came to Australia. This choice was ‘informed consent’ to be bound by the laws surrounding work restrictions.”
True again…..in my case. But, it would seem from online chat in various Australian Doctor fora (and others), not in the case of other doctors. It is not a great mental leap to imagine that the complex medical practice laws – both federal and state – may be difficult to interpret from a foreign country when one’s first language is not English.
Anyway, since when did foreknowledge of a discriminatory law make it suddenly non-discriminatory? It is still just as wrong.
Back to the Racial Discrimination Act, s10. The foreword that underpins the whole thrust of the legislation reads (and, although a bit wordy, it is important; a sentinel paragraph – integral to a just society):
If, by reason of, or of a provision of, a law of the Commonwealth or of a State or Territory, persons
of a particular race, colour or national or ethnic origin do not enjoy a right that is enjoyed by
persons of another race, colour or national or ethnic origin, or enjoy a right to a more limited
extent than persons of another race, colour or national or ethnic origin, then, notwithstanding
anything in that law, persons of the first mentioned race, colour or national or ethnic origin shall,
by force of this section, enjoy that right to the same extent as persons of that other race, colour or
national or ethnic origin.
Quite simply, my national origin has restricted my right to freedom to choose where I work.
“But the rural and remote populations need doctors – this legislation is for them.”
An easy one!
As pointed out above, over a thirteen year trial, this policy has failed. IT DOESN’T WORK. This is broadly recognised. If you don’t believe our peak professional bodies, ask the regional populations themselves if things are better or worse than in 1997.
Apart from that, the moral and legal rebuttal is that ‘the ends never justify the means’. To have it any other way would negate one of the fundamental principles of our society’s governance.
Which brings us back to the issue of Indian students.
Federal and state governments are making strenuous public efforts – both nationally and internationally – to reassure the Indian government and population that Australia is not racist.
But how can it reassure foreign students that the Australian populace is not racist or discriminatory when the Commonwealth itself ignores its own anti-discrimination legislation? Pots and kettles come clanging to mind. On issues such as this, one has to lead from the front.
It is notable that New Zealand – which has a similar medical system to Australia – recognised the obvious discrimination in this policy by overturning their equivalent of 19AB in 1998. (Northern Regional Health Authority v Human Rights Commission 2 NZLR 218). Why is Australia lagging behind its neighbour by twelve years?
The minor amendments to 19AB that will pass into law this year are to be congratulated, but they should only be the start of dismantling this discriminatory and divisive legislation that has served to retard medical provision and human rights in Australia for too long.
So what is the alternative?
Well, the reality is that approximately 40% of the rural/remote workforce is made up of OTDs. As much as I profoundly object to the moratorium, it is this reality upon which regional medical provision has become based. To suddenly rescind 19AB would be to pull the rug out from under rural and remote healthcare, as many of the affected doctors would immediately relocate to metropolitan areas. An untenable solution for workforce reasons both out bush and in town.
I believe that the solution lies in the current crop of medical students. There is a significant bulge coming through the system and they will be ready for practise in the next few years. It is vital that they are directed towards regional work as a mandatory part of post-graduate training. No letters after the name until a significant period (perhaps two years) has been spent regionally. This will not be popular – but it is vital.
Those entering medical school will no doubt be aware (perhaps more so than OTDs studying Australian geography from overseas) that Australia is a vast continent with a disparately placed population, some of which is quite deprived.
This population is entitled to healthcare provision by those entering our vocation. (And it is just that – a vocation. Not merely a nine-to-five job.) There is an obligation incumbent on doctors born, raised and educated in Australia to understand this geographic healthcare dilemma. When a career in medicine is first contemplated (with all its attendant rewards over the long-term), this consideration and societal obligation should be part of the equation. This duty cannot and should not merely be devolved upon the OTD group, as it has for so long.
But – and please note this – I am not suggesting that the term spent regionally should be charity work. Rural and remote work is tough and should be handsomely financially recompensed. Any doctor returning to metropolitan work after this period in their training should return enriched – in terms of knowledge, skills – and financially.
A proportion of doctors will stay in the bush, thus providing long-term, ongoing medical care and training to the next generation. Those who return will be, perhaps, more highly skilled than any post-graduate training group to date. And this will surely benefit metro areas. For example, A GP with the myriad practical skills attained during regional postgraduate training may well be content to undertake many of the more minor procedures currently often reserved for Emergency Departments. This would serve to provide some relief for our metropolitan hospitals.
Additionally, OTDs will be required to show a significant commitment to this, their host country, by undertaking to practise regionally for a period equivalent to the local postgraduate group. This must, however, be with the supports appropriate to their needs.
I believe that this medical commitment and societal obligation applies equally to me. I am writing this from a very remote location, having brought my wife and three kids out for a year (or more) of Aboriginal Healthcare work in the Kimberleys, despite having had no obligation upon me to have left my home town of Melbourne.
There are two important bonuses that would stem from this reduced time constraint on practise for OTDs.
1) Many doctors from other first-world countries are mightily put off by the current ten year moratorium. A relaxation would encourage immigration of highly skilled doctors (trained in medical systems directly comparable with Australia’s) to rural areas. Overall control of medical immigration is – as it has always been – encompassed within the Immigration Department’s Skilled Occupations List. Once satisfactory numbers of doctors are attained in a particular specialty, that specialty is removed from the list of those professions deemed desirable to Australia’s immigration needs.
2) Attraction of these doctors would put a constraint on the current locations from which overseas doctors are sourced. It cannot have escaped notice that a significant proportion of our current OTDs come from second and third-world countries – exactly those countries that can least afford to train and then lose their medical workforce. This ‘poaching’ constitutes an unethical recruiting practise and should stop. It would stop more readily if there was a viable alternative source of doctors for our regional areas.
I suggest that the ten year moratorium (encompassed within subsections 1 and 2 of s19AB) be gradually phased out. This is accomplishable under the legislation – as it currently stands.
The 19AB legislation also contains subsection 3. This allows for exemption from the ten year moratorium by dint of ministerial discretion. There is carte blanche within subsection 3 for the Minister for Health to exempt any practitioner for any reason.
This could be applied to successive groups of OTDs – perhaps related to time spent in Australia, practitioner’s age, university of graduation or any other variable that would gradually diminish the size of the overall OTD population affected by the legislation.
The timeframe for progressive groups’ exemptions would reflect the progress of medical graduates through their postgraduate training, with its mandatory regional training component. There would be no deficit in the medical provision to regional populations with such an advance-planned, steady ‘workforce replacement’ program. I am sure that numbers of doctors working regionally would actually be boosted in the short and medium terms and, with appropriate governmental supports, those workforce numbers sustained in the longer term.
By next Australia Day, I shall be a citizen. I will celebrate Australia’s proud recent history of inclusivity. But I shall also be acutely aware that in this, the second decade of the twenty first century, current discriminatory legislation continues to set me apart from my peers and adversely affects many, many others in its broad wake. Progressively entitling all OTDs to exactly the same working rights as our fellow Australians – the very same rights that you enjoy through your fortuitous accident of birth – is vital to Australia. It constitutes ‘a fair go’.
Jonny Levy.Share on Facebook
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Last Year’s Income Tax Return
Details of any purchases or sale of shares, property, business
Private Health Insurance Details
Children’s details including D.O.B and whether you currently receive any Centrelink benefits
Pensions or Government payments/Allowances
Interest earned for the relevant year from the banks, building societies or other institutions.
Details of any rental property income
Details of any business income
Details of any other income earned
Work Related Expenses (tools, education, uniform, union fees)
Motor Vehicle Expenses (estimation of Kilometres if no logbook kept, otherwise logbook and all expense items)
Investment Expenses (bank fees, financial advisors fees, investment borrowings etc)
Rental Property Expenses (rates, body corporate, property agents fees, borrowing cost insurance, interest on loan, repairs and maintenance, cleaning, pest control, gardening, travel, water rates, depreciation schedule, etc)
Cost of managing tax affairs
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