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Finally a Good News Story

Posted by Iain on May 21, 2021, 11:16 a.m. in Healthcare

 

In 2018 we agreed to represent a couple in their early fifties from South Africa. Let’s call them Joe and Lucy (not their real names obviously). With to be under 56 years old to file a resident visa as skilled migrants, the clock was ticking. We had moved this couple’s daughter and grandchildren to New Zealand a few years earlier. All three adult children were by then living in New Zealand. Among all the advisers they could have chosen, this couple chose us on the back of their New Zealand based family’s advice.

Quick background. Client arrived in NZ, did all the usual stuff of trying to find skilled employment, suffering rejection along the way - no work visa, no interview, disinterest by recruiters because of visa status, HR Managers not wanting to involve themselves in visa processes, employer wariness, blah blah blah. The usual story. After a few months Lucy found a great job, well suited to her history in technical sales management. We secured her a job specific work visa. We secured Joe a partnership based work visa. He arrived and used that job to secure work with the NZ Government.

Around the time she secured her role, we filed their Expression of Interest given the clients had a prima facie claim to 160 plus points. As expected it was selected quickly and they were invited to file their resident visa application. We did so in March 2020.

Into the so called ‘managed queue’ (backlog) the application went. Then it was likely to take two years to secure residence.  Our advice was unless Lucy could find a higher paying job and we could get her case transferred into the ‘priority processing queue’ she could do nothing but put her life on hold and be patient. Like so many trying to escape the 30 month wait for residence these days, Lucy went and found that better paying job. We got her a variation of conditions to her work visa to take up the new job.

So far so good. So far so normal… 18 months since we met for the first time.

In July 2020 a bombshell. Joe was diagnosed with possible colo-rectal cancer. The couple realised immediately the implications for their future in New Zealand.

Migrants are expected to have a very high standard of health to secure residence at the time the decision on their residence is made (unfairly, not when the government takes their money). The rules are pretty clear when it comes to cancer - an applicant will not be deemed to be of an ‘acceptable standard’, if the chances of them being alive 5 years after diagnosis and treatment isn’t at least 90%.  Following treatment, involving pre-surgery chemo, Joe provided us with advice from his Oncologist that his odds of survival to 5 years was only between 50% and 70%.  A bitter blow. I tried to delay INZ making a decision for as long as possible to allow the maximum time for Joe to start his recovery and for us to get feedback on the success of the operation. I asked them to put someone else in that queue ahead of Joe and Lucy - it would make no difference to INZ but potentially be a game changer for Joe. Any way we sliced it Joe was not, on the face of it, going to be eligible any longer. INZ would have none of it (even though they don’t mind operating a 24-month processing queue and we only filed residence in July 2020).

Immigration policy allows someone applying for residence to seek what is called a medical waiver. This basically allows an applicant to put forward the best possible evidence for allowing them to stay. As part of the medical waiver all parties recognise the health of that person is not up to scratch. It is not a box ticking exercise and is highly subjective. The arguments must be carefully presented and the evidence of a high standard.

In this case we essentially argued:

     All of Lucy’s adult family and her grandchildren live in New Zealand - she is close by in the event the family needed help and support and not 16,000km away

     Lucy has no immediate family left in South Africa 

     One of Lucy’s adult children in NZ has, since he was granted residence, developed a degenerative disease - forcing his mother to leave when she can offer support to him, his partner and his children would be unreasonable and inhumane 

     Lucy had a well-paying job at least twice the median average - well paying enough to get her priority processing of her residence based on (the spurious in my view) ‘value’ (according to INZ management) she represents to the economy

     Lucy and Joe were increasingly well settled and contributing to the economy 

     Lucy had a level of specialist skill that INZ had recognised through the grant of her work visa which could not have been granted if INZ felt a local was being denied a job

     Over her and Joe’s remaining guaranteed working lives they’d contribute at least $450,000 in personal taxes (with Lucy the bulk of that) far outstripping any possible cost for any potential future treatment for Joe i.e. they would likely be net contributors to NZ’s tax base even if Joe needs further treatment

     The inability of the Health Ministry to quantify the cost of any future treatment that ‘may’ (according to the immigration rule book) be required. On these criteria he might need nothing or he might need a lot - such is the nature of cancer diagnosis and treatment.

That final point was the real eye opener for me and shows how asking the right questions can have such a huge impact on outcomes - his Specialist who did the operation, like so many specialists in NZ is a self employed private practitioner who works in the public system. Obviously he has his charges that the tax payers front but it was incredible to me to learn that the heath system itself could not tell him, and therefore us, what the cost of this future treatment might be. Or what the tax payers had paid for the treatment to date. A stunning and very useful revelation and any Immigration Advisers reading this should take note! In my view if INZ could not quantify the future cost that ‘might’ be required and given while Joe is on his current work visa (valid like everyone thanks to Covid, till December 2020) he is covered by the public health system anyway (that’s why if you plan on staying 12 months or more you have to do a full medical to get a work visa), then the ‘cost’ was impossible for INZ to pin down. It would not be fair in our view to deny someone residence citing possible cost if the Government itself cannot tell us what that cost was or might be.

I confess quietly I wasn’t quite so confident but in my mind I thought if the residence was declined there was a very good argument for humanitarian approval under appeal given the facts above. What bothered me was having a client with a known probability of survival in five years as low as 50% was not a great hand to play. However, given at IMMagine we had argued many medical waivers including a number of clients who had been diagnosed and treated for cancer for far less than 5 years I was not without a strong sense of conviction it was a medical waiver, that when all other factors were taken into account, should be approved.

But this is INZ we are talking about…

We were therefore excited and proud beyond words when the case was approved on 20 May. INZ accepted our arguments. 

This is the part of this job I love. To present that precious resident visa to a couple we have collectively worked our butts off for three years to deliver a future in NZ to. It is these complex cases that get me out of bed in the morning and which will likely be the death of me. To deal with the curveballs so many cases throw at us and to hit them out of the ballpark is immensely satisfying. The cases where emotions run high. Lucy’s employer pressured her to take the case off us and to a big law firm when the cancer was diagnosed. She refused. Lucy wanted to stay the course with IMMagine given the faith she had in our team.

They made it. Standing atop the mountain enjoying the view. Exhausted. Relieved. Elated. 

I wish them and their extended family many happy years together.

Until next week

Iain MacLeod

Southern Man


WANTED: Migrants with the Health of Olympians

Posted by Iain on May 17, 2019, 5:13 p.m. in Healthcare

In these days of work visas for main applicants (and student and temporary visas for their remaining family) taking up to 4 months to be allocated before being processed, ensuring a visa application is fully and correctly documented to get it into the priority allocation queue is increasingly critical. 

In our experience two major factors that slow down visa allocations and processing is meeting the health and education (for dependent children) standard for the duration of the visa being applied for. Not being in tiptop condition is inviting delays. 

I could not tell you the last time we had a work visa declined on medical grounds, but plenty require scrutiny by the Department’s medical assessors. That can add weeks to the process. Recent analysis of our own applications for work visas for skilled migrants saw around 25% of the 350 we have filed in the past year requiring a recommendation by the departmental doctors on approving or not.

There were some very common ‘conditions’, in particular with South Africans.

The three most common are:

  1. Obesity (including hypertension and or high cholesterol)
  2. Anxiety and/or depression
  3. Children with ADHD or mild autism spectrum disorder

None of these in and of themselves need to be deal breakers but all potentially cause delays and if the delay is too long it could cause the New Zealand employer to withdraw the job offer and there goes the work Visa and probably residency.

Anyone that has a Body Mass Index (BMI) of 30 is deemed to be obese. Once the BMI rises to 35 (far more common than you might think), an applicant is deemed to be morbidly obese. The obese applicant is usually going to be required to provide evidence they are otherwise healthy, the morbidly obese tend to require specialist reports including cardiology, often pulmonology and sometimes liver scans. All of that cost a lot of money but more importantly cost time. 

We do have a significant proportion of our South African clients who do have BMIs higher than 30 and or have hypertension and or have high cholesterol. While they always tell us they are healthy and it is not a problem, they need to understand the decision to let them into New Zealand (or not) is based on the "likely" health costs that the New Zealand tax payer will pick up over the duration of the work Visa for which they are applying. Then, when it comes to a resident visa application, the bar is even higher because the timeline they are being assessed against in terms of probable costs is far longer. Passing the health test therefore at work visa stage is no guarantee it won't be a dealbreaker at residency. 

My advice? If your BMI is 30 or more you need to do something about it. I am not a nutritionist nor doctor and not about to start giving advice on lifestyle and diet but you don't need to be a rocket scientist to appreciate that for most of us we carry extra weight primarily because of what we put in our mouths.

Anxiety and depression is another very commonly diagnosed South African ailment. I appreciate that South Africa is an incredibly stressful place to live, for those looking to migrate the economic pressures are often mounting by the day and psychologically when you are losing hope that tomorrow will be as good as today, it means there are large numbers of people suffering from anxiety and or depression. In and of itself this too is not a dealbreaker necessarily, but where people are being medicated and/or have been hospitalised for treatment and/or assessment, they will face close scrutiny from the departmental medical assessors. Hospitalisation in particular has been the cause of many visas being declined down the years, even if that hospitalisation was only for assessment to diagnose the condition. Thankfully none of our clients, as we were able to argue that the likely cost to New Zealand was not going to be significant no matter what the history.

My advice? Where it is medically sensible and appropriate to come off medication you should try and do so before you get to New Zealand. Again, I'm not holding myself out to be a psychologist but I do wonder if a lot more people in South Africa might not be given alternative therapies to pills. It does seem to me that the answer to most things in South Africa is a bottle of pills and I'm not sure if that is a medical system that is not socialised/public or it’s simply easier for the doctors to prescribe pills rather than alternatives. 

ADHD/Mild autism spectrum disorder. We see this a lot particularly in South African children but also in Singapore. I am not quite sure what it is with children's behaviour that they need to have a label slapped on them and treatment rendered and I find it extraordinary the number of clients we see specifically from Singapore and South Africa who are diagnosed with these conditions. I sometimes wonder if there's something in the drinking water. (Although I read a fascinating article yesterday on trial therapies involving gut bacteria). I suspect however it has more to do with a pressure cooker education system in Singapore and the clients that we consult with sending their children to private schools in South Africa. 

The good news is, it is not normally a dealbreaker because in New Zealand children with ADHD or mild autism spectrum disorder will be mainstreamed and not sent to a special or remedial school as is very common in South Africa. In fact I cannot tell you how many times clients have arrived in New Zealand, put their children into school having taken them off their medication in South Africa and the New Zealand school had no idea these children had any "condition" at all. 

In regard to children with one of these conditions they are assessed against the likely cost of any special education need they might have and also the medical cost. So be careful and assume nothing.

My advice? Make sure you get a letter from an educational or developmental psychologist in South Africa, Singapore or wherever you come from and make sure these are filed with your child's student Visa application. In addition to that if they are on medication you should provide details of the medication and the dosages. That does not mean the department will not come back and ask for more but if this information is loaded with the child's application and it's worded appropriately covering all the issues that the department is interested in they could normally expect to be approved. 

With ever increasing delays in processing work and other temporary visas it has never been more important to understand the criteria against which the visa is being assessed (as best as you can when you're not an expert) and then to try and mitigate that by understanding what treatments and services are available in New Zealand and how you or your child fit into that treatment regime and the cost associated with it for New Zealanders. For, in the end, it is the cost to the New Zealand tax payer and what your child or you will require in terms of health or education need that determines whether or not the visas will be issued – not the cost or needs in the applicant’s home country.

Until next week...

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The Cost of Obesity

Posted by Iain on April 29, 2016, 7:09 p.m. in Healthcare

Good immigration advice really is invaluable when you are planning the rest of your life (and possibly your children’s).

Providing that advice can at times be uncomfortable but if we had a motto at IMMagine it would surely be ‘we are going to tell you what you need to know, not what you want to hear’.

Over the past three weeks I have consulted with over 100 families in South Africa interested in a move to New Zealand. Of that 100 I’d suggest at least 60% were seriously over weight and had some other weight related issues such as hyper tension, diabetes or high cholesterol. Lurking beneath all that flesh I suspect were more than a few ‘fatty livers’.

At times I felt more like a Nutritionist than an Immigration Adviser.

The risk of being obese is that you won’t get into the country. Being overweight can be the difference between that new life you seek or not.

Immigration policy is concerned that once an applicant’s Body Mass Index (BMI) gets to 35 or more they have the potential to become a ‘cost’ the publicly funded health system.

Government concerns are twofold – not just the cost to treat those that do not look after their physical health in future years but the fact that we have so many obese people of our own. In fact New Zealand is suffering a self-inflicted obesity epidemic as we pile on the weight. We have one of the fattest populations in the world and diabetes is increasing at a rate that is quite simply alarming.

What we don’t wish to do is to add to an already escalating funding crisis in public health by adding more obese people.

The Doctors that sit is judgement on an applicant’s health are New Zealand Doctors who know the pressures our tax payer funded model is under with ever increasing costs of care and an ageing population. Their loyalty, to put it bluntly, is not to the obese who wish to come to the country, but to those who will fund the health care if they do.

Having a BMI over 35 isn’t in itself a deal breaker but so many of those I see have other co-morbidity factors that add to the risk – and risk is what we are out to minimise. I have successfully argued that a client who had a BMI of 47 (and she was, to put it politely, huge) was not in fact unhealthy or a risk. It took 12 months of fighting the immigration authorities and Cardiology, Pulmonology, Nephrology and god knows how many other ‘ology’ reports but all proved, along with text book blood pressure, this applicant was undoubtedly extremely overweight but she was not unhealthy. I suspect however that she was the exception.

Practically however ‘simply’ being overweight can cause things to go awry. Most clients do their first medical when they secure a skilled job offer. A process, when you know what you are doing, that usually takes 3-4 weeks.

When there is s BMI of 35 and or other co-morbidity factors, Immigration Officers do not make the decision on health – they send the medical off to one of their Assessors for an opinion. I’d suggest at least 70% of the time the Assessor asks for re-tests on certain organ functions, adding weeks more to an already nerve wracking time for the client (not to mention their Adviser).

On more than one occasion clients I warned when we met many months earlier of the risk of not shedding kilograms have, to coin a South African term, ‘thrown their toys out of the cot’ over the delays caused by these medical referrals. At times it has come very close to those people losing their jobs and it is only our powers of persuasion coupled with a reasonable degree of knowledge on who is and isn’t a future potential risk that has kept them in the game.

The frustrating part for me is that I warn every single one of them when we meet if I feel health is going to be an issue. While there isn’t much one can do about many conditions, for the most part everyone can do something about their weight and if they do that they will find the other factors associated with those are relieved.

On this trip I met a young man who had in the past had Type II diabetes and hyper-tension. He knew he had to lose the weight to minimise the risk that his family’s move would be jeopardised. He lost 40kg in the past 5 months and his diabetes and hypertension were gone. Not minimised, gone.

So it can be done. Weight is so easy to put on and so hard to take off (trust me, I am also trying to lose a few kilograms) but if it is the difference between getting your family to New Zealand or not surely it is worth it as difficult as it might be.

There is much that applicants cannot control in this game but their weight is not one of them. It is in their hands (literally) to do something about it.

Until next week...

Iain MacLeod, Southern Man

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