On Friday night, the Brisbane Mater Hospital confirmed that 24-year-old asylum seeker Hamid Kehazaei’s life support had been turned off.
It has been widely reported that the young Iranian had developed sepsis – also known as septicaemia – and subsequently suffered a heart attack which left him brain dead.
Mr Kehazaei’s death raises a series of difficult questions about the appropriateness of Australia’s offshore detention centres, questions that become all the harder to answer when the characteristics of sepsis are brought into the story.
Griffith University Professor Leanne Aitkin is a sepsis expert, and says the condition is best understood as the second stage in a two-part process.
“Somebody doesn’t get sepsis as the first problem. They will usually have had some sort of local infection – that might be an infection as a wound or it might be a respiratory infection or a urinary tract infection,” Professor Aitkin says.
“It’s only when that infection progresses to effecting multiple organs in their body that somebody is considered to have sepsis.”
Once sepsis has developed, the patient is at great risk. According to Aitkin, sepsis has a 20 per cent fatality rate in Australia, but the number is far higher in under-developed countries. The Global Sepsis Alliance says one third of the 26 million annual sepsis cases globally result in a fatality.
But relatively harmless infections can be prevented from developing into sepsis if they are quickly and appropriate cleared out and, if need be, surgery is performed.
“So it’s really; get rid of the infection, and treat it with the appropriate antibiotics if it’s a bacterial infection,” says Aitkin.
Given that unattended infections can trigger such devastating consequences, there’s already a lot to be concerned about in regards to Mr Kehazaei’s internment on Manus Island.
Doctors and those in contact with asylum seekers have long warned of the centre’s dangerous conditions, and that it’s common for those held to have to walk through open sewerage barefoot or in thongs.
Refugee advocates also say asylum seekers are forced to wait for treatment and that guards, not nurses or doctors, are sometimes involved in triage.
Aside from minimising and managing exposure to infections, Aitkin says that a rapid response is vital in order to head-off sepsis developing. When a systematic infection has developed, studies show patient outcomes are improved by intervention within six hours.
“Time is of the essence when it’s a local infection and time is even more of the essence when it’s a systemic infection, so when it’s become sepsis,” Aitkin says.
Writing in The Conversation, Ian Kerridge (an Associate Professor in bioethics) and David Isaacs (Professor of Paediatric Infectious Diseases) have already raised issues around the timeliness of Mr Kehazaei’s treatment.
“What happened to Hamid Kehazaei raises concerns about the adequacy of care provided to him during initial treatment, including wound care and antibiotics, and how soon he was transferred to expert medical care, first to Port Moresby and subsequently to Brisbane.”
A key measure when assessing the care given to Mr Kehazaei will be who first responded to his requests for help, what their level of medical training was, and how long it took for his complaints to result in treatment.
Conclusive proof that his treatment was delayed, as has been alleged by Greens Senator Sarah Hanson-Young, will be damning.
According to Aitkin, general awareness of sepsis and the risks associated with the condition are poor.
“One of the challenges is that because people start with all sorts of different infections, we often don’t realise that people die from sepsis,” says Aitkin.
“For example, (Pope John Paul II), according to the media, died of a urinary tract infection, but by the time he died of it, it would no doubt have been sepsis.”
Next Saturday marks world sepsis day, organised to help draw the condition to the public’s attention.
Back in Australia, two concurrent inquiries into Mr Kehazaei’s death may eventually provide us with answers to help piece together how a simple foot injury was able to kill an apparently healthy 24-year-old man.
Immigration Minister Scott Morrison has confirmed that a ‘clinical review’ will be conducted by the Department of Immigration’s chief medical officer and the Queensland coroner will also hold an inquiry.
Given the backlog of claims about the Department of Immigration’s tendencies to delay medical evacuations, the Coronial inquiry could be of particular interest, unmoored from the self-interest of the Department’s internal review.
That said, if it’s anything like previous reviews of Manus, the facts that come to light won’t tell us much we don’t already know about the implications of holding asylum seekers in offshore detentions centres.
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