The availability of female doctors and allied health staff was a concern raised at PIDC (though this appeared to be less of an issue at BRP and VIDC). The matter was raised by women in detention and on review of the DCC Minutes for August 2023.168 The Commission was informed that a male doctor was available on site at PIDC 4 days a week and any appointments requiring a female doctors needed to be undertaken at an external medical centre. This caused short delays to receiving care and could be problematic for women who refused to attend external appointments due to the need to be restrained. One woman told the Commission, ‘I don’t want to go out of the centre because of the restraints’. Continuity of care Another area of concern that arose in our interviews with women and IHMS staff was the continuity of care for women transferring to immigration detention from prisons. IHMS staff at BRP, VIDC and PIDC told us that accessing health records from prisons (particularly if interstate) could be problematic. In some locations, it would take over a week to receive the health records. One woman at BRP told the Commission how this had impacted her when she first arrived: ‘I take medication daily and that was a pain to get when I first got here — I had left over medication in my suitcase and some trouble getting my medical records from prison. So [they couldn’t] give me a prescription until I got it. Got it sorted [out] in the end’. At VIDC another woman also told us, ‘[a]ll reports from Corrections went missing – I had to get them myself. I was on a drug treatment program – this just stopped. I got Panadol but otherwise had to go cold turkey in quarantine’. Continuity of care issues for women transferring between immigration detention centres were also highlighted as a concern. One woman told the Commission that she had been recommended a specific treatment plan by an external specialist and upon transferring to another centre was unable to start the treatment. After accessing another specialist, 11 months later, she was provided with the same treatment plan. IHMS staff told us that some women are eligible to access the private health system due to long wait times arising from transferring between centres. However, private care can sometimes be challenging when providers are reluctant to provide care due to security concerns. In many circumstances, the entire process is restarted when a transfer occurs. IHMS staff also advised that they could recommend no transfers between centres where women are on waiting list for a treatment regime, however, this advice could be overridden by the Department. Screening at induction The Bangkok Rules note at Rule 6(c) that ‘[t]he health screening of women prisoners shall include comprehensive screening to determine primary health‑care needs, and also shall determine: The reproductive health history of the woman prisoner, including current or recent pregnancies, childbirth and any related reproductive health issues’.169 The Commission was advised that induction screening included a female health screen and reproductive health screening, including history of reproductive testing. The screening process also included other factors relevant to Rule 6, including screening for experiences of domestic violence and trauma.170 One issue the Commission explored with IHMS was the absence of auditory screening during the medical induction (for both men and women). For people with a hearing impairment, the detention environment can present subtle but significant challenges in understanding verbal instructions, hearing loudspeaker announcements or audible alarms, and generally engaging in routine daily activities. In Australia, around 3.6 million people experience some form of hearing loss.171The Western Australian Inspector of Custodial Services has reported that ‘[w]hile there is limited research on hearing impairment in Australian custodial settings, it is estimated that rates of impairment are higher than in the community’.172 40 Not just an afterthoughtThe experience of women in immigration detention