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Dr Sue Packer AM, Child at Risk Assessment Unit, Canberra Hospital, 17 October 2014

MONICA LINDEMANN: Good morning, ladies and gentlemen, and welcome once again to the October edition of Landmark Women. My name is Monica Lindemann. I am head of development and I am very pleased to see you all here today. It is my great pleasure to introduce this month’s very special speaker.

Dr Sue Packer is our guest today. Dr Packer has dedicated decades to improve the lives of children who have been abused or neglected. She has been a paediatrician since 1972 and has worked in the ACT since moving here in 1980. She has a long list of voluntary roles all dedicated to the improvement of lives of children, including serving on the boards of the National Association for Prevention of Child Abuse and Neglect, KidSafe and the Defence for Children International.

Dr Packer was made a member of the Order of Australia in 1999 for services to child welfare, paediatrics and the public. She was named Canberra citizen of the year just last year in recognition of her personal efforts and significant contributions to the ACT community, particularly as an advocate for the safety and well-being of children.

Dr Packer is also the chair of the ACT government’s Mr Fluffy reference group leading a group of nine members to help inform government policy regarding the future of more than 1000 Canberra home owners affected which the Mr Fluffy asbestos insulation. In addition to all of this, Dr Packer is also a mother of three. Please welcome Dr Packer to the stage. [applause]

Dr SUE PACKER: Good morning. It’s lovely to see you all. This is the moment when you suddenly get scared and think what was I going to talk about anyway? I guess the main thing is firstly I have been doing things for a very long time. I thought I would start off with one of my favourite posters. This is one of a series of posters painted especially for NAPCAN, that is the National Association for Prevention of Child Abuse and Neglect, by an Aboriginal artist Tex Skuthorpe who took a series of traditional Aboriginal stories with a child protection meaning and painted and donated them to NAPCAN. This is the sentinel one which says children are sacred. The child, which is very obvious as the little pink sacred person in the middle, with the two initiated parents. The parents are supported in looking after their child and bringing their child up by all the people in their community, and their community is part of a bigger lot of support through the surrounding communities. So there are many layers of people with a responsibility for this child. If anything happens to harm this child, the response is not to look for someone to blame but for the whole community to jointly bear the blame for not looking after the child.

This is very important in several ways: firstly because we are very much a blaming society; and, secondly, because we so often look at the negative picture of Aborigines, what has happened to them after 200-plus years of colonisation and total destruction of their previous living structure. It’s a harsh lesson for us on what can happen when all the basic rules and expectations for your civilisation are overwhelmed by something else. Just generally I just like the picture. I thought I would leave that up there while I was talking to remind me.

Another component of that - it’s the things you discover in retrospect which are probably very important in your life – is my very dearly beloved uncle was a professor of anthropology here at the Australian National University, Professor Stanner, who was instrumental in developing the AIATSIS institute across the road, which is one of my favourite places. Particularly there is the Stanner Reading Room there which to me is a very special room. But more than that, as a small growing up child at that time when Australia at a time when Australia was really in the height of white Australia policy and very prejudiced against everybody else, he was a person whose everyday living was to tell me of the wonderful complex culture of Australian Aborigines. So that was what I grew up with.

I have never really forgiven him. My sister and I wanted to go with him when he went on one of his excursions to the Northern Territory, and we helped pack his truck and load all these funny things like tinned butter. We really, really wanted to go with him but he absolutely refused to take us. Just imagine having two small girls going across the Northern Territory. His way of dealing with it for us was to say, ‘I can hear what would happen. You would get up there and you would start complaining. “Uncle Bill, there are flies in the milk,” and he’d say, “They’re not flies, they are tadpoles. And it’s not milk, it’s muddy water and drink it.”‘ That was his experience of the Northern Territory but it also I think showed the fortunateness of that aspect of my childhood in having that sort of experience.

I then thought what sort of message would I like to leave you people at the end. I guess it comes down to having a fresh look at children. Australia as a country is not great in its record for loving children. We love our own children intensely most of the time. But as a community children are seen more as a nuisance, a threat, an expensive time consumer, an expensive consumer of resources. They are not terribly well regarded. If people start thinking again about children, their abilities, the environment we are providing for them to grow up, which is a big worry for me, and their needs - and perhaps in the course of this revisit the inner child within us all.

One of the most interesting things about our attitude to children is that somehow we forget as adults we were children. I am not a terribly religious person but I do go back to quoting the Bible when it said: ’When I became a man I put away childish things.’ I think this is one of the saddest losses of knowledge in our civilization, because we learn so much as children about people and about people’s responses. You keep getting arrested in the most unlikely places.

I was reading a rather horrible and bloodthirsty whodunit about a child who was supposed to have murdered someone and was on the run. One of the things thought by this child was that every adult has been a child but they have forgotten how to think as a child; no child has been an adult but they rapidly learn how adults think and how to respond to them. That is interesting to think about.

I guess I have reflected on this a lot in the course of my work with abused and neglected children. These are children who can’t rely on caring adults to watch out for things and to watch out for them. The capacity of these children to continually check their environment and have to make their own decisions and make their own judgments overwhelms me at times. It distresses me enormously at times, and obviously many of these children make wrong judgments and wrong decisions.

On the basis of all this, the essence of my whole message would be to delight in children. Not only delight in them but learn ways of showing your delight. That doesn’t mean that everything children do is wonderful; they know it’s not wonderful; and they want to be told it’s not wonderful. But at times when you are enjoying being with a child, I think it’s wonderful to be able to sit back and really enjoy that.

My other thought after all these years of work is that so much of what happens with children we are doing to children and doing for children. As a doctor I do a moderate amount of doing to children. This involves things like medical procedures and investigations, immunisation. Children don’t have any choice in this. The family don’t have a lot of choice. You are directly doing things to children.

Most of what we do in the everyday world is doing for children. When we love our children and we want the best for them, we conscientiously try to provide the best food, the best accommodation and the best clothing, toys and whatever else. But at times we don’t actually sit back and think: What contribution can the child make to this? Are we making the right choices?

It is so much more delightful and enjoyable when you do things with a child. It can be anything from out in the garden with a child or cooking - though cooking has to be done when you are not under pressure. There is nothing worse than a chaotic cooking session with an enthusiastic young child, but at the same time if you leave it until you know the floor needs washing anyway, that can be a great fun. Doing with children is something I think in our time poor society we don’t do nearly enough and we tend to do it a lot on our own terms - you can do this with me. We don’t sit back and look at the possibilities of what the child can initiate to do with them. Yet in the middle of all this, by the time they are in their late teens we expect them to be pretty well responsible adults yet with very little opportunity to learn the skills they are going to need to be a responsible adult.

So children particularly in our society when we have this enforced long period of childhood, with children being financially dependent on their adults and their parents and other people, this seems so often now to extend into the 20s and 30s and even beyond that and we are not quite sure how to deal with it. Somewhere along the line in the middle of all this, children are supposed to develop into individual and responsible adults. I think it is increasingly difficult for this to happen. In a way in the past when you knew you were out of the house when you finished school or else you had to stay at home until you turn 21 and got the key of the door, got married or whatever else and you were out of the house. It might not have been ideal, but there were very clear expectations.

Now children are somehow as adolescents supposed to pick up the right messages but in a world where our own messages to them are very confused. I think the passage to adulthood for a lot of young people is much more difficult than it used to be. You don’t particularly like having to be dependent until you are very much older.

I seem to be getting more and more depressed about these things. The last sentence I have written down about this is one which arrested me many years ago - I think it was one of the big nature studies before David Attenborough’s Ascent of Man, Origin of Species or one of those ones. The standout comment there was ‘when a species loses its capacity to rear its young, the species perishes’. Again this probably comes more from working in medicine, most young families taking a baby home from hospital these days have had nothing to do with babies before the baby for whom they have total responsibility is placed in their hands. And on top of that, these days you are usually home by day two. I think there are community supports, but I think back to when I was supposed to know all about babies - I was a paediatrician when I had my children and I found it extraordinarily challenging when the babies didn’t do what the books said they should do. The help that came in was not always helpful. In fact, it was often felt to be very critical. This is a very hard world in which to bring up a baby. Now we have young people saying, ‘But we don’t intend to change our life for the child.’ The child has different ideas, I think.

Again we are expecting these people to do these things with a huge emphasis on material stuff that you need for a child and an expectation that your child will have a considerable time in child care. Many mothers in particular have been delighting in staying home with their baby but are made to feel guilty and selfish for depriving their baby of a socialising experience. This at a time when we are learning more and more in an almost terrifying way about the way the brain develops in the first year of life. I find this extremely exciting but it is worrying.

I went to a conference on children and trauma only a couple of months ago with some very eminent researchers from America. The evidence is all pointing to the fact that the right hemisphere of the brain, the side that is to do more with feelings, emotions, perceptions, is the predominant hemisphere to develop in the first year of life. It’s the subtle interactions with a small number of known care givers which give the best development to the right hemisphere. This is the combination of the wonderful zingy connecting moments you occasionally get with your child and the calm reflective times you spend with your child.

My concern is that, even in the most conscientious and well-run child care, you don’t get many of those moments. You have people who care very much, who provide good things, but they don’t have the overwhelming emotional investment in that child that a parent has. In the long term is this going to be significant? If you look at the child today we don’t think so but do we know so? Particularly when we have a world where we are getting increasing incidence of mental health problems, is this a contributor? We don’t know. To an extent the way we are bringing up our children now is a social experiment, and I think most of us are not terribly interested. The only driver for child care has nothing to do with the child’s development. It is to get the women back into the work force and to provide something for the children which is good enough for the families to accept. It is not the best we can provide as an alternative.

I will get on to my next hobby horse after that which is education, which is very much the same. In this country we provide what is good enough to get us over the line on the few measures we make of how well children are educated. I include in this NAPLAN, which is more a measure of the tools than the education - it is obviously critical that children learn to read, but we have done very badly in some places for children learning to read, and particularly for the children that I have so much to do with who don’t get the help they need at home.

But all NAPLAN is really doing in a way is more in keeping with the way I was tested at school more than half a century ago and that is measuring the end product that these children can do mathematical processes, can read, have some ability to comprehend and now we want to add a little more grammar and punctuation as well. But in terms of an education which encourages children to think, to question, to experiment and to explore, we aren’t doing terribly well in Australia.

The better measure is probably the OECD measure of education. One of the lowest scoring countries in that is America. The highest scoring one, which always makes us very frustrated, is usually Finland, Norway, Sweden and the Scandinavian countries. If we are looking at what is provided in both those countries, in the countries that are doing the best they have a uniform high standard of education, people who train as teachers have the highest school leaving scores, are highly regarded and are highly paid because their critical task of teaching children to learn.

We always have and always will have some wonderful, inspired and dedicated teachers here. This is despite the fact that entry level for education in this country is the lowest acceptable tertiary entrance scores. Many people get into there knowing it is the best opportunity for a university education. For some people they do develop into wonderful teachers. But despite the dedicated efforts of many people also within the education facilities, many people end up in teaching in a very much a default way and are quite overwhelmed and bewildered by the tasks in front of them.

Again I see the worst side of this because I go into school advocating for abused and neglected children who have not learnt to interact with other people, who have not learnt to communicate appropriately and who are in many cases something close to nightmares in school but the schools are supposed to accommodate them. The public system has very little choice. The private system can exclude children like this, but within the public system I am repeatedly being told, ‘We will only have this child in school if they are medicated.’ The medication doesn’t do a great deal. And again nobody asks the children how they feel on medication. The parents, doctors and teachers will say he behaves better, but many of these children, if you ask them, have quite significant confusion and bewilderment on medication. It might not make them feel great. Are there other ways we can do it better? Do we actually look at why these children don’t settle in and what other things might help?

A beginning one which is glaringly obvious is that the amount of physical activity in school these days is way, way down. I don’t mean formal organised sport but sort of running the fidgets out of children. If you have come from living in an apartment, and increasingly children are living in apartments, to school where you are supposed to sit down and concentrate, I think most children are a whole heap better off if the fidgets are run out of them a couple of times a day. If this can be done as well with some more exciting dancing, rhythmic activities or whatever else happens to entice a group of children, I think it would be so much better. But so much of what we do with children is again doing for and doing to and not doing with.

I have had a recent grumble of my concerns about our new and expensive and in many ways wonderful Women and Children’s Hospital we have built here in the ACT. My concern is that any child going into that building would be hard pressed to know that it’s a building for children. It’s tricky because it’s a hospital for women and children, and many women coming in would not be overly impressed or overly encouraged by having a very obvious children’s hospital. But even if you move away from the front entrance to the paediatric part of the hospital, it is more like a modern minimalist hotel than a children’s hospital. The amount of consultation we had for that hospital was overwhelming. Yet even with all of this, which didn’t include consulting children because we don’t know how to do it, we in many ways still got it wrong. I think we have many challenges and many lessons if we are to better look after children.

But the way it has ended up now, if you are a child in for a short time feeling ill with a committed family with the facilities to stay with you, it is probably not bad at all. You are in a single room with your Mum or Dad, you are looked after all the time and you go home and you are looked after. If you have parents who are exhausted, bewildered, fed up then being shut in a room with them is not a great thing. Or you might be shut in a room without them, and that’s not a great thing either. If your parents want a lot of help, it can be very much harder to access help from a single room than from having a number of people in a room together. We are basically communal animals. We are not animals that live in little individual cells but that’s the way we have ended up. If you are a Mum who is really struggling and who needs more help, it’s much easier to get that in the open ward. But we are so scared of germs these days that the germs have won.

It does sound negative, doesn’t it, but it’s not. In the middle you have all these amazing kids. If you sit back and actually look at each child individually, as you tend to do with your own children and grandchildren, you can delight in them enormously. You are overwhelmed by their talents, and one of their talents is for new electronic equipment. But are we so surprised? If you look around shopping centres, you look when you are out, you have a child on the one hand and the mother has a device in the other hand and most of the attention is to the device not the child. I hear some lovely chatting and look to see what’s happening, but it’s the machine that is being talked to not the child. Is it surprising the child will then pick up anything of that shape, hold it to its mouth and from the very earliest months try to imitate a mobile phone? Then to keep them quiet, they rapidly learn much quicker than old people how to use all the buttons on the phone. That delights everybody and they say, ‘Come and see what he can do with the phone.’

But then a few years later when you can’t get them off the thing, it’s the child’s fault. It is just something we need to think through again. It’s a fact of life. We all use them. We all love them. You sit in a doctor’s waiting room now, you don’t have murder and mayhem, you have a row of little kids playing with buttons. They are very well behaved but it’s something totally different. The children accommodate these things much faster than we do. They get a lot of delight out of them and I think they can be used very beneficially. But they are a significant change and they are a worry.

One of the best things I have done in my occasional bit of retirement is start to build a small children’s garden in the front of the yard, because it’s quite close to a child care centre and early childhood school. One of the delightful teachers there periodically brings these four year olds up to check on my garden. They send me letters telling me maybe what I ought to do instead. Are the paths going to lead anywhere interesting? Do you think you will keep chooks in the barn? And things like that. It is fascinating to see children using an outdoor space and having ideas and thinking through things and working out what’s going to happen.

But how many opportunities do they have? Just imagine if you are parents with a child or several children living in an apartment and you have a small outdoor balcony perhaps - this for children is terrifying. That’s something I have brought up with builders, and they tell me it’s not an issue. Even if you have very safe heights and structures, what enterprising child is not going to push something over to the side and climb up? And children do fall off balconies. So the use children can make of balconies unsupervised is very limited. So the alternative is to take them outside to play. You can’t leave little children outside playing without a grownup watching them, so their capacity for prolonged, relaxed, experimental diving in and out of things play diminishes to almost zero. Very few parents can put up with more than an half an hour in the playground. They then think of some way to take the child home. Yet this is happening all the time.

I first thought of this a long time ago when I was working in London and I had an Australian cousin over there - I never saw her in Australia but I saw her quite a bit in London. Her husband had a very good job and she was in a very nice flat in a very nice part of London. Her nearest green area to play happened to be Kensington Gardens, but that was the only place these children could play in. It sounds lovely in a way. She would take these lively little boys out, play around Kensington Gardens for a while, negotiate the traffic, come home to the mess and the chaos and everything else, knowing that the husband was bringing significant people home for dinner. It’s not a good way for children to grow up. It’s becoming the norm.

If we pride ourselves as Australians as these enterprising, high initiative, outdoor, energetic people, this is not the generation of children we are bringing up. We are bringing up a very different generation of children. We are quite relieved they like their computer games and things, although we feel a bit guilty because they sit and eat and get fat - then we have another worry. What are we doing about it in a big way?

One of the things I really celebrate now is this last weekend was the opening of the boundless playground. This is a wonderful idea and a wonderful initiative. It’s the sort of thing that makes me love being in Canberra. They have built this wonderful playground for children of all abilities and disabilities to be able to participate fully. I am about to go and try it out with a group of people, I hope. Things like that for children with the community behind it doing something to give children a good, challenging time. The plan with this is to give children the opportunity to have to think of other ways to do things, and that is what so often is missing now. You have prefabricated, brightly-coloured, uni-purpose toys. Even more they are often strongly promoted with the film or other production to have the right characters, the right games and everything else, yet we want imaginative children. So what are we going to do about it?

What are the consequences? This is more from my work of not seeing children. We can immediately think if a child is not seen we don’t know if they are hurting, we don’t know what is happening to them. Small bits of not seeing I think are quite good. One of the delights of my childhood in the Blue Mountains was growing up. The next stop after our fence was a gully. Provided we were within cooee literally, we played in the gully. We did all manner of things we shouldn’t have done. We had a wonderful time sorting them out and working out how to get out of the scrapes we got into.

We had a safe enough and well-known enough neighbourhood that many people scolded me and threatened to tell my mother about the things I was doing. But children just don’t have these opportunities to do wonderful things. It was a really wonderful community. One week we had rain like we have had this week. I and my mates from all the next houses were out in the rain. We had an unmade road with an unmade gutter and our game for that day was to dam up this gutter until the water went to the middle of the road. It was a dead-end street. It was wonderful. It kept us busy for hours. I remember lying flat on my tummy on the wet road with my arm down to the bottom of the dam and it didn’t quite reach it.

One of the men walking home came past it, and his comment was ‘Well you work harder than the council, don’t you?’ The more I think of it now the more I think what a wonderful comment it was. I think I was picked up by the scruff of the neck at the door and dropped in the bath and that was the end of the game, and presumably some grown-ups overnight removed our huge hazard from the middle of the road. We had played our game until its completion, and that was fine.

How many opportunities do kids in Canberra have for that ‘play to the limit’ sort of play? I saw a very good survey in Western Australian child care what they tried to find out from the children, they asked one little boy why he didn’t play with the blocks. He said, ‘I just start to build something interesting and you make me pack them away.’ This childcare centre started saying, ‘Right, each child can play with their toys until they finished. They have a responsibility to put them away when they finish but they can play all day.’

Similarly with meals. The meal would be delivered, but if you are in the middle of a game and you are told the meal is ready, the children who had been got up early were ready for their meal and were ready to have a rest but the other children could play provided they played quietly and didn’t disturb the other children. The ones that really didn’t want to have a sleep could play quietly and not have a sleep.

Some of the traditional carers in this place were terrified. They thought it would be mayhem and run amuck. But it actually ran extremely well and the children became far more considerate of each other. But we are so used to doing things in pattern and to conform that our expectations of conformity are getting more and more.

Obviously we are worried if we don’t see children who get harmed. You get the occasionally appalling story of a child abducted by strangers and killed, but this continues to overlook the fact that 99 other children are abused in their family and not seen outside the family. My feeling again is if we had communities that really kept an eye on all children in their communities, the occasional abduction would be harder to happen. I think repeatedly of the little Bulger boy in England. To walk with a screaming distressed toddler through a shopping centre without any adult saying, ‘what’s going on here?’ is a terrifying thing to think about, to have it as somebody else’s business. I think keeping an eye on children is everybody’s business. The older you get, the easier it is to say, ‘What is going on here? Do you need some help?’

One of the most searing experiences I have had this year was from DCI going the Inverbrackie detention centre, before it was closed, as part of the inquiry of children into detention. I had to interview some families. In fact, I had to interview about ten families in one day through an interpreter, which was quite overwhelming about aspects of being there with their children.

The hopelessness in that place continues to be a nightmare. These were very ordinary families. Most had come down because the women were having a baby and they came down to have the baby. None of them knew where they were going. They were all terrified that they were going to be sent to Manus Island or Nauru and I think this has subsequently happened. The depression in these mothers were such - these were the mothers who subsequently were on suicide watch when they came back because their reasoning had got to the point of thinking, ‘Well if I try to commit suicide, maybe my baby will be safe.’

Most of the people I saw were Rohingya from Burma. If they stayed in Burma, they risked being killed. They had no opportunity ever to work; they had no opportunity for health care; and their children had no opportunity for education. I wonder how I would respond in a situation like that. It just worried me. Inverbrachie was the best detention centre. It was an old Defence Housing place with very reasonable accommodation, a bit shabby but okay, but you had no decision making capacity whatsoever. There were enough houses for each family to have a house, but the decision was that families had to share houses and you had no choice in who you shared with.

You had a kitchen to cook your own food and there was small store where you could for points buy food. That was infinitely better than most other places, but there was still this degree of control. The children could go to school part time a few days a week. Their bags were checked every day when they came in and they mostly had a body search. This is for a secure facility for low risk people. There was a playground, but the children were not allowed into the playground without parents if they were under 12 years of age, so the playgrounds were scarcely used.

The final straw for me was reading in the Canberra Times that these families were removed from this place at 3 a.m. What is it like being woken in the middle of the night to be told you were leaving. I am sure they weren’t told before, because already in this low risk security place these people had four checks a day, four counts to make sure they were there, and two of these were photo ones which meant the guard had a list of the photos and would check with the photos. The last one of these was at night so these sleeping children had a torch shone in their face to compare them with the photos. And this is our most humane facility in a humane country. It is just not good enough.

Then we spend time the rest of the time worrying about abuse in children. What are the benefits of noticing children? The first thing is that to see a world afresh through a child’s eye can be quite an arresting experience. I work with a delightful principal who said kids would come up to him and say, ‘Sir can we do this?’ He said, ‘Your instinctive adult response is to say no. But then he’d think why not?’ Again when you think through some of these ideas, they are fantastic. This man also said to the teachers, ‘If you haven’t learnt anything from the children in your class today you haven’t been listening.’ The third thing was if the children in your class are feeling secure and are well fed, you can’t stop them learning. We need to have that positive enthusiastic attitude when working with children to help encourage us to think more and more.

It does us a lot of good to rethink a lot of our entrenched ideas. Why have we always done it that way? Is there another way of doing it? Would the world fall apart if we did it differently? Is it worth at least trying something else out? If you are doing nothing else with these children, the children you treat in this way are going to be infinitely more sensitive kids, responsive carers for all of us in our old age than children who have been told to do as they are told.

I have spoken a little bit about the new and ongoing discoveries about babies’ brains. This all started about the time I was really getting immersed in my child abuse work and several things worried me enormously. The first thing at the time was my children were quite small. I had children who were very dubious about staying with anyone else and were very much happier being at home. I was seeing children two, three, four and five years of age who had been abruptly removed from their homes because of concerns for their safety, put in a car by strange people, brought to see me - another strange person - in a strange building and persuaded to be stripped to be examined. These children didn’t protest; they didn’t cry; they were not distressed. Some of them did their best to engage me by being particularly loving, coming and sitting on my lap, telling me they loved me, drawing love hearts. To me these were terrifying behaviours.

Most of the child protection workers with them would say, ‘He’s a good little kid, isn’t he?’ Nobody was saying, ‘Why are children behaving in this outlandishly abnormal way?’ If somebody had tried to remove my children from me, take them off in a car, take them to a stranger, strip them and examine them, they would have had a huge job on their hands or else the children would have been freaked out and absolutely despondent and despairing. I never see that response. What are these children’s lives like every day that they have learnt to accommodate the totally unexpected, the totally unknown and deal with it in a calm and accepting way. This is one of the things that worries me most.

From thinking about this we have actually learnt that, from before they are born, babies are responding to influences from outside. Before birth some of this is hormonal. So if you have a stressed mother living in domestic violence, the hormonal responses to this baby’s brain are already impairing the final development of the baby’s brain, and obviously there are the direct insults from noise and blows.

Once the baby is born, from the time they were born - I was tempted to put two more slides up there; they took a video of babies at the time of birth looking at social interaction. Here was a one-hour-old baby boy born, quite a good delivery, everything was going fine. He was handed to his Dad to hold while they were tidying Mum up, and somebody must have suggested to Dad that he poke his tongue out. So you have this picture of this Dad looking at his new son, very proud of himself, proud of the baby. The Dad pokes his tongue out at the baby, and the baby four seconds later pokes his tongue out at the Dad. The Dad didn’t quite believe it, did it again and the baby responded faster.

We now know there are very clever neurons that do this called mirror neurons, but in terms of a totally helpless baby enlisting somebody to be there to care for them, what better thing could that baby have done? Dad went from saying ‘my son’ to ‘wow, he loves me, he’s mine.’ The increased capacity then to keep that baby safe is huge, yet we somewhat ignore this. We make bland comments like ‘it’s good for bonding if you are there when the baby is born,’ and all the rest of it. It’s within limits and we are doing a lot now in a theoretical way rather than in a known intergenerational way. We also know that from that very early age if a baby is exposed to stress and distress and pain, it is permanently registered in their brain and affects their capacity to form lasting, trusting relationships.

How did I end up at this point in my life? I sometimes wonder. I was born in the middle of the war. This same uncle who had considerable skills with Aborigines was working in the Northern Territory with the Aboriginal contingent of the army who had to provide a lookout for the whole of the top end of Australia to let it know of any possible arrival by Japanese boats. He knew how dangerous and perilous things were and kept saying to my mother to get out of Sydney. The obstetrician knew how dangerous and perilous things were and said, ‘Don’t you dare move.’ It was probably just as well she didn’t because she had a very complicated time and probably would have died if she was not in Sydney, and then my life would have been totally different.

From being born in Sydney we moved up to the Blue Mountains and I spent my untrammelled childhood running fairly wild in the Blue Mountains between Springwood, Hazelbrook, Lawson, Leura and Katoomba. My mother was a teacher. She was a very good teacher. She was an absolutely committed teacher. In fact, that was interesting in itself because she also had had a tough time. Her father had died when she was one, and her mother had an extraordinarily tough time. All of the effort was put, as it was in those days, to educating the brothers. She had a very good job as a shorthand typist and she was supposed to help support the brothers. She came home and said, ‘I am going to be a teacher.’ It was not very well thought of at the time but she became a magnificent teacher. And then it was just as well because my father, although a delightful person in many ways, an absolutely disastrous husband and father and many other things. So my mother had to go back to work. If she had not been a teacher, again our lives would have been very different.

Anyway she taught. We moved up to the mountains and she taught in different schools. Along the line I think I had my tonsils out and bled and had to have blood tests. I was about six and rounded on my mother and said, ‘You never told me there were lady doctors,’ and she said, ‘I didn’t know that you wanted to know.’ I won’t say it was an absolutely driving ambition from then but it was something I knew could happen. I then got in to medicine at Sydney University but I really didn’t think there were any other doctors other than GPs. Hello to my friend from Sydney University (in audience). That was interesting too. We lived in a small hostel so I developed a lot of counselling, management and other skills as one of the more senior people at the hostel over the years which have stood me in very good stead since. It was a very good community living experience.

I graduated and I went to St Vincent’s Hospital. I always thought I would be a GP. In those days you didn’t have to be vocationally registered. But I was sensible enough to know all the things I didn’t know so I thought I better do some more obstetrics and paediatrics before I did that. So I did six months more obstetrics, which taught me a lot more things, and then I tried to do six months paediatrics and they said, ‘We don’t do that any more, you have to do a year.’ So I did a year and they said, ‘When are you sitting for your specialist exams?’ I said I didn’t think I would. ‘Nonsense’, said the professor. Three or four years later I sat for the exams and passed them but I still, other than being a paediatrician, hadn’t thought what I do. He needed a paediatric gastroenterologist and suggested I did that.

So I went to England to learn to be a paediatric gastroenterologist. The first thing I learnt - I was doing a big study on children with coeliac disease and in the middle of this huge study in England were a number of really worrying families with children with what I now know to be factitious illness, with the parent, a very troubled parent, seeing the child as a sick child, treating the child as a sick child, and not wanting anything to change this. I can remember being stunned with one little girl saying to the mother with great delight, ‘This is wonderful news. She has all her enzymes. She doesn’t have coeliac disease.’ The mother was so furious she stormed out with the child. I began to realise that being a parent and being a child was far more complex than I had thought.

Child abuse was not recognised as a medical issue at that time. It was just beginning to emerge - they were realising that children with bruises and broken bones might have been deliberately harmed. I guess in many ways over the course of my career we have learnt a lot. Anyway that turned me off from paediatric gastroenterology into becoming a community paediatrician and then specialising in this.

Again there were two sentinel people in my doing this. The first one even before I went to England to do gastroenterology was working with Dr Alan Walker in the Northern Territory. At that time he was the only paediatrician for the top half of the Northern Territory. When I went up as his junior registrar assistant, I was the second doctor for the paediatrician for the top half of the Northern Territory. It was the first time I had really worked with Aboriginal families living in their communities. It was the first time I had worked in a remote part of the Northern Territory. And this was not long before Cyclone Tracy. It made me realise there is just so much complexity to looking after children in community and looking after children’s health in the community.

Then I went to England and worked with another very impressive paediatrician David Hull who set up the paediatric school in Nottingham. He was really interested in community paediatrics. He felt that the hospital is the peak of the iceberg for a few sick children and that most of looking after children should happen with them in their homes. I guess this is where it has come from.

While I was over there I met my husband. We stayed there for some years while he did his PhD in electronics in Nottingham when I did the work with David Hull. Then my mother became ill, and she had moved to Canberra by this time. So I came over here with two small boys while he finished his PhD and organised the house. He then came out and joined me here. I had my daughter as well. And of course we have been here ever since. It wasn’t originally our intention but, once the children start school in a place, it’s rather hard to move once they have all their friends.

My husband is Welsh. The ties with Wales remain, and my children feel they have two definite identities. It’s very interesting having spent time in two very different communities - a small rural Welsh community where things only change about every 50 years, I think, which has its pluses and minuses. The stability is there but the prejudices are huge. I would come from Canberra from a very busy time over here and would think ‘why can’t Canberra be more like this’, and then after a while with the prejudicie and frustrations I would be pleased to come back here again.

My children have grown up here. Five years ago my husband died here very suddenly and unexpectedly, and that gave me my own personal learning about trauma. It also gave me my own personal learning about the critical importance of friends of every dimension from family friends, work friends, community. I would not have continued without it. But it also means now that, instead of a life of retirement with a husband doing goodness what we would do - we were still debating that one; we had lots of debates because we had different priorities - in a way it has freed me up to keep working. I enjoy my work immensely. I continue to learn. Apart from having three extremely bossy adult children who keep telling me that I need to think about what I am doing and be more sensible, it generally is working quite well.

It was a huge honour last year to be the citizen of the year. Not only was it an honour, it was not a terribly onerous responsibility. But then that’s been reversed this year by Katie Gallagher who said seeing I was citizen of the year last year I could chair the community and expert reference group for the asbestos task force this year, and that is not a sweet and social job. It is going to be a nightmare of a job because it is a nightmare of a problem. The one thing again which is wonderful is working with a very committed and dedicated group of people and doing a lot more learning.

This is where my second slide comes in. Another one of Tex’s beautiful artworks. This is probably my very favourite one and it is called the galah and the boobunge. It’s the story of a young Aboriginal boy learning to throw the boomerang. He was practicing and practicing, and one of the elders walked by and the kid could not resist the opportunity to show off. But things went terribly wrong and the boomerang hit the old man on the head, knocked out a bit of his hair and caused a bit of bleeding. The kid was appalled and frightened and ran off and hid under a prickle bush. The old man was furious and chased him and rolled him in the prickles.

The great creator looked down on all this and was most displeased because the old man should have known that this boy was learning, he would make mistakes, and it was his job to help him with his mistakes and help him with his learning. The boy should have known that the old man was the bearer of the knowledge, he was the teacher, he needed to treat him with respect, he needed to have been sorry. So the great creator dealt with his fury by turning the prickly little boy into a boobung lizard which has prickles on it and turning the angry old man into a galah. We know the story is true because if you look at a galah it has a bit of a bald patch up the top with some red at the bottom of it. What both of these people needed to keep in mind all the time was mutual respect: respect by the adult for the child because he was the learner and he was the one that was going to carry on the knowledge; and respect from the child to the adult because he had the knowledge and was teaching him.

This particular picture has helped me in my working life and probably my private life more than anything else - this whole idea of impossible situations with sometimes impossible people. If I walk down the hall towards the meeting saying ‘mutual respect, mutual respect, mutual respect’, I get a lot further. I think it is something I will be saying to myself quite a lot over the next while I am working with the asbestos group - working with wonderful people but with issues which are hugely challenging. I think that’s all I have to say. Thank you. [applause]

FRANCES BALDWIN: Thank you so much, Sue. That was a fantastic talk. We have time for a couple of questions if anybody would like to ask Sue anything. Thousands us of questions - yes I have thousands too.

QUESTION: I just wondered if you have a view on the current trend of a lot of parents to put a sheet or a blanket over a pram so a child has no interaction with the face they see and they are shut off from the world in a dark world.

Dr SUE PACKER: This confuses me a lot. I think it’s advice from one of the books on bringing up babies. I personally think it’s distressing. I can’t think of anything better than to wake up in my pram and see my Mum’s face. Equally I get concerned about all the easily collapsible pushchair things in which the child is heading head first into the world and nobody is paying attention.

Again that’s a story that comes back to this very clever uncle of mine that makes you think way back when he was a baby in the olden days, you had prams where the handle went either way and I gather he demanded to be sat in the pram from the time he could scarcely sit so he could see his Mum and would be immensely distressed if he was put in the pram the other way so he couldn’t. Again I think many babies are not given the choice. It’s one of these things that happens. I think this happens with so many things: we just start a habit and see other people doing it and you keep doing it too. But if you look at things from a baby’s perspective you will often make a different decision.

QUESTION: I am just wondering with your studies about personalities being formed from nought to seven whether with severely abused and neglected children you have often seen cases where they can reverse that and through counselling or group therapies they do end up being successful people?

Dr SUE PACKER: One of the things which I probably should have spoken of at great length is my enormous respect for the children I work with and being quite astounded by what they achieve. Most of these kids come into adult life in an everyday sense being indistinguishable from other children, but the scars are there. I think they are scars both for potential mental health problems in adverse circumstances but, more than anything, they are scars for low self-esteem. They are consequences, but it doesn’t mean any of these things are hopeless. It still means you have a fine person who has been somewhat shaped by their experiences.

Some of these most abused little babies have ended up being individuals who still as adults in a stressful situation will dissociate, absolutely blank off from the world around them because that’s how they survived as little people. So they survive as adults by dissociating, and many of them have trouble trusting other people in relationships. If you know you have a problem, you can seek help and you can often do well. Some of the difficulties are recognising that you have a problem. It’s the same with parenting. If you have been extraordinarily badly parented, it’s going to be harder for you to parent. There are so many more things now we can do to help but you have to recognise that you need help before we can help.

FRANCES BALDWIN: Could everybody join me again in thanking Dr Packer for the wonderful talk. We can talk to her more down in the Friends Lounge if you would like to join us for morning tea. [applause]

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Date published: 27 November 2014

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