Source: https://drandrewrowland.wordpress.com/2014/06/
Timestamp: 2019-04-25 10:32:28+00:00

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This week I’ve been in Hong Kong at the International Conference on Emergency Medicine (ICEM) hosted by the International Federation for Emergency Medicine (IFEM).
It has been another busy week! Along with a trainee, Dr Anna Williams from Birmingham, I helped to run a 3 hour rolling workshop on the emergency assessment of children with potential neck injuries. I can’t really take any credit for the preparation or creation of the workshop as this was expertly done by Anna including QR codes and translation of part of it into Mandarin but I very much enjoyed the discussions that I had with the delegates who attended. In particular the discussions with attendees from Australia were really interesting – rather than using three-point cervical spine immobilisation (using a hard collar, blocks and tapes) the Australians simply use a hard collar for routine cases, without apparent adverse consequences.
The teaching we do in the UK generally comes from the Advanced Paediatric Life Support organisation (ALSG) who are currently updating their teaching materials for the next edition of the course which should be released in the near future. I hope that they will consider the Australian experiences, and the evidence behind this, as if we are able to move away from the full protection we currently use, towards a system of primarily using hard collars only, this would be much more pleasant for the children involved and a lot easier for the staff!
Later in the week I was invited to deliver a training workshop at the British Consulate in Hong Kong to teach staff about the recognition of potential cases of child abuse when they are undertaking welfare visits or are carrying out their consular duties. As well as British Consulate staff from Hong Kong we were also joined by a member of staff who had travelled from the Consulate in Guangzhou (China) and representatives from the Embassy of the United States of America, the Embassy of Switzerland and the Embassy of Sweden. It was a truly international workshop!
One of the things that stuck me from the discussions and questions following my presentation is that Consular staff overseas would welcome access to appropriate experts back in the UK who are able to provide advice about the more difficult cases they deal with. I have therefore come up with the idea of developing a Pro-Bono Child Protection Advisory Panel (PB-CPAP), potentially hosted by the Foreign and Commonwealth Office (FCO) in London, to provide advice if requested. There is already precedent within the FCO – I’m a member of the pro-bono (ie without charge) medical panel to review cases of deaths of British Citizens abroad (in my case to look at childhood deaths) – so the infrastructure already exists to create such a PB-CPAP and I hope that there will be further discussions about this in due course.
I ended the week with an invited lecture on the recognition of child abuse in children who present to Emergency Departments. This was the first opportunity I have had to start disseminating some of the learning I have gained from my Winston Churchill Fellowship travels which began back in April 2014. There were people present from a number of countries around the world and there was a great question at the end of my presentation from a colleague in Cardiff about Mandatory Reporting (a topic I have not forgotten about and will be declaring my views on in the near future). It has been really good to get individual feedback from people telling me how their clinical practise will change as a result of the presentation I gave – this is a boost for me to hear and should also be good for children who attend Emergency Departments whether or not they are at risk of physical abuse, sexual abuse, emotional abuse, neglect, exploitation or trafficking.
It is on these latter two aspects that there have been significant developments back in the UK during this week with the government’s publication of the Modern Slavery Bill 2014 (which they hope to enact as the Modern Slavery Act 2014).
I have written previously about my views on earlier drafts of this legislation, which has undergone some modification since the first version was released, but now that it is about to undergo its second reading in the Houses of Parliament it is crucial that the parliamentarians that will be discussing and debating this legislation recognise that the legislation, if enacted in its current form, will not deliver the protection to children that it ought to do.
This is particularly problematic for a number of reasons. Section 1 currently defines slavery in accordance with Article 4 of the Human Rights Convention (HRC) however Article 4 doesn’t actually define slavery in sufficient detail therefore it is not possible to construe section 1 in accordance with Article 4 of the HRC in any meaningful way, leaving this Modern Slavery Bill 2014 without a clear definition of slavery.
Given the inadequate definition of slavery and servitude it is, in my view, likely that the cases which will be recognised or dealt with will be the headline-grabbing ones, well publicised in the media, rather than the majority of cases where the evidence may be somewhat weaker or the cases themselves may not be as headline-grabbing. It is therefore likely to be the case that professionals may still not recognise cases they are dealing with as ‘slavery’ or other offences dealt with under this proposed legislation. Although this Bill is clearly intended to be a criminal Bill it is important that there is consistency with civil protection rights for children, such as under the Children Act 1989, such that the cases where evidence is weaker, but children are still at risk, are properly dealt with.
In interpreting the concepts under Article 4 of the Convention there are international instruments which are relied upon, such as the 1926 Slavery Convention (Siliadin v. France, § 122), Supplementary Convention on the Abolition of Slavery, the Slave Trade and Institutions and Practices Similar to Slavery (C.N. and V. v. France, § 90), ILO Convention No. 29 (Forced Labour Convention) (Van der Mussele v. Belgium, § 32) and Council of Europe Convention on Action against Trafficking in Human Beings and the Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women and Children supplementing the United Nations Convention against Transnational Organised Crime, 2000 (Rantsev v. Cyprus and Russia, § 282).
“the status or condition of a person over whom any or all of the powers attaching to the right of ownership are exercised” (Siliadin v. France, § 122).
“a particularly serious form of denial of freedom” including “in addition to the obligation to perform certain services for others … the obligation for the [person] to live on another person’s property and the impossibility of altering his condition” (Siliadin v. France, § 123).
(4) For example, regard may be had to any of the person’s personal circumstances (such as their age, family relationships, the presence of any disability, and any mental or physical illness) which may make the person more vulnerable than other persons.
This is too weak. It refers back to section 1 which, as discussed above, is non-specific. Section 3 therefore needs tightening which could be resolved by revising Section 1 as described above. As currently worded it will be difficult for professionals to know whether or not the behaviour is slavery or servitude and it will be difficult for appropriate guidance to be developed which is consistent across England and Wales. Consistency is incredibly important in child protection cases and, if for that reason alone, Section 1 and, by reference, Section 3 ought to be more fully detailed.
I would prefer this section to be expanded to include offences under Section 1(1)(a), (b) and (c) of the Protection of Children Act 1978 rather than just (a) so that it applies to the distribution of, showing of or possessing with intent to distribute, indecent photographs of children rather than just the taking of them or permitting of taking of them as it is my belief that these are all forms of exploitation in its widest sense even if the perpetrator of offences under Sections 1(1)(b) and 1(1)(c) does not necessarily know the individual child involved.
This ought to have a definition of ‘young’ to make explicitly clear that the definition of a child is someone who has not reached their 18th birthday.
Unfortunately this section currently just applies to “trafficking” and excludes “exploitation, slavery, servitude and forced or compulsory labour”. This Section therefore ought to refer not just to Section 2, as it does currently, but to Sections 1 and 3 as well.
This Section cross-references Schedule 2 which purely deals with trafficking. This section needs to be re-worded and re-cross-referenced so that it includes proper references to all of the definitions of offences set out in the proposed revised preamble I have set out above.
This is too weak. At present the provision of information, education or training is optional under this section. This must to be changed such that the provision of information and standardised educational or training material(s) is mandatory in order that duplication of effort at a regional or local level is minimised and so that standardisation of education and training across England and Wales is more likely to be facilitated.
This needs to be tightened to cross reference Section 2 (and not just 1 and 3).
These need to be revised to include exploitation as at present the mandatory guidance under this section applies purely to trafficking and slavery.
This needs to be revised to include exploitation, servitude and slavery (not just trafficking).
Turning something as important as child trafficking and exploitation into a headline-grabbing piece of legislation, by using the emotive term ‘slavery’, is only appropriate if the substance of that legislation is comprehensive enough, and detailed enough, to really make a difference to the people it is designed to protect whether through punishment of offenders or prevention of offences. In its current form the Modern Slavery Bill 2014 lacks that detail and it is beholden upon everyone involved in our parliamentary processes to make the changes I believe are necessary to improve it into powerful primary legislation that will be more likely to better protect children from exploitation and trafficking, and appropriately punish those people responsible for these heinous crimes against society.
I’m very sad to say that my travels are coming to an end and I will shortly have to return to the UK – where I’ll be attending the Annual Representative Meeting of the British Medical Association and then I’m sitting as a tribunal chairman for a week before returning to my clinical job on Friday 11 July 2014, in my new personalised Caribbean Blue Scrubs which are, apparently, waiting for me!
The process of turning everything I have seen and learned over the past three months will then begin and I hope to have a comprehensive report ready for publication by 31 October 2014. Condensing everything I have experienced since I left the UK on 13 April 2014 is going to be a significant challenge! It will take a great deal of thinking and a lot of reflection to come up with a series of recommendations that can realistically be worked on and implemented in the future.
That reflection process will certainly be helped by sitting quietly, emptying my mind of extraneous thoughts, watching the sun set once more over the ocean from Ku De Ta and relaxing in the peaceful tranquillity that is Uma Sapna, Seminyak, Indonesia – a place of total serenity – where I am spending two nights in quiet contemplation before heading back to Singapore.
I’m now in Sihanoukville spending time with the fantastic organisation M’Lop Tapang, which means “under the protection of the umbrella tree”. I survived Cambodian immigration and a 3.5 hour “seat-gripping” car journey down to the south west of the country which included an unscheduled stop to pick up a Buddhist Monk for a lift on the way.
The driver had but a few words of English and the Monk had none. I have about two words of poorly pronounced Khmer. It made for a particularly quiet car journey but we managed to some how communicate using our hands, facial expressions, body language and a lot of laughter – especially when our route was blocked by some free-roaming cows!
The place I’m staying in Sihanoukville is a ChildSafe hotel. It is estimated that over 14000 street children live in Cambodia. The term “street children” is not one that I particularly like as it can label children inappropriately but it is really a short-hand way of saying “children who live or work on the streets or beaches of countries around the world”. All of these children are at greater risk of being abused and often have difficulty, for a variety of reasons, accessing healthcare including in an emergency. Units such as the one I work in back in Manchester don’t exist here and the children who are living or working on the streets are often dependent on healthcare being taken to them rather than expecting them to access fixed facilities. More about the mobile medical team, another time!
Travellers to countries such as Cambodia can often unwittingly and unknowingly increase the vulnerability of these children and it is for that reason, as someone who loves to travel, I’ve decided to write about the ChildSafe initiative.
ChildSafe doesn’t just work in Cambodia. They have projects running in Thailand, Lao PDR and Indonesia. They help to protect children on the beaches, on the streets, in internet cafés, in hotels and guesthouses, in restaurants, and in the transport and tuk-tuk industry.
There are seven simple ways you can help to better protect children in other countries and indeed back in the UK or the country where you live.
So, how can this help us back at home? Well, for a start experiencing other cultures, other countries and the work of other organisations enhances our knowledge, makes us more attuned to the specific strengths and weaknesses of the communities that people live in, gives us a worldwide perspective to our work and enables us to more fully understand the background circumstances that some of our patients, or the people with whom we interact or work, may have come from.
Global tourism is big business. A significant number of people from within the UK travel abroad throughout the year and we have one of the busiest airports in the world in London bringing people to or through our country. But what can you do to help those children who might otherwise be harmed?
You don’t have to donate any money to be able to help those children in other countries who might be at risk of abuse; you don’t have to give of your time to try to reduce the chances of them being exploited and you don’t have to volunteer, or make significant changes to the way that you live or spend your holidays, to make a real difference to the lives of children which otherwise might be ruined by abuse, exploitation and trafficking.
What do you have to do? Well, it is very easy. All you have to do is to choose carefully and think is the service you are about to use, or the place you are about to stay, or the retailer you are about buy something from, “ChildSafe”. That’s it – simple really ;-).

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