The Plight of Rural Healthcare

This mornings’ discussion on Twitter in support of Telederm, made me think about the difficulties faced by our rural communities especially when it comes to healthcare funding.  Having spend the majority of my career in rural and remote placings, I think I have a reasonable handle on the concept and can comment with some authority.

I think that one of the biggest problems facing healthcare provision in the bush, is the ever increasing idea of centralization of services.  NSW was the first state to embrace this new-found idea and we saw local board-run hospitals amalgamated into ever increasing Health Care Services and in the end have a service covering an area twice the size of Belgium.  This has since happened in most other states too and my most recent experience was in country South Australia with the “worst-of-them-all” health service, Country Health SA (CHSA).

Here is a health service, with it’s head office in Adelaide, and officials that can not pinpoint most of the town that fall under them on a map.  The problem with these massive health services is that they have no concept of what is happening on the ground, yet they try to employ a blanket ruling on how healthcare should be provided throughout.  The other problem, and maybe this is the “biggie” is that they just don’t care.  As long as there are adequate funds being pumped into the large cities, the powers-that-be care very little about what happens in the bush.

For 13 months, I worked in the small town of Penola, 50km from Mt Gambier, in the beautiful Coonawarra region of SA.  I was the only doctor in town and looked after the small hospital, an ED, two age care facilities with 36 beds (18 high and 18 low care beds) and a busy GP practice.  I worked 5 days a week and some days saw up to 60 patients a day and was on call every day, 24hrs a day, 7 days a week.  I was also expected to stay within 30min radius of the hospital, which in effect meant that I could go nowhere.  Now I have asked CHSA on a number of occasions for some time off.  There answer was that I can have time off only if I arrange locum cover and only if I give them 3 months’ notice.  This while interns and registrars fall over each others’ feet in Mt Gambier.

The bed in the ED was a modified trolley and by no means a “crash-bed” which made the few resuscitations I had to do very challenging.  I have brought this under the attention of CHSA on a number of occasions and their answer was that there was no money in the budget.  Yet they approved a $12mil upgrade of the Mt Gambier ED.

As rural communities, we are bottom-feeders and seen to be lucky to get anything at all.  Our patients are the ones that have to travel hundreds of kilometers to see a specialist and wait months before doing so, just to be told by the registrar to come back next week to check your dressing; yes sure, it’s only 400km away.

And why are we accepting this?  Well, we are not, but our voices does not get heard, because most of the rural areas are in what the Pollies call “safe seats” thus making any fuss about it, a waste of their precious time.  Healthcare, along with education, welfare and now the NBN, has become a political carrot which the Pollies can hang in front of the voters’ noses.  When it comes to delivering on these promises, the carrot is usually nowhere to be found or at the post long eaten by the city dwellers.

What is the answer?  Well for a start give the control back to the local communities who know what their community needs and then fund them well.  I’ll use the Penola model again as an example.  In the days when the hospital was board run, the hospital board were made up of volunteers, local business people who donated there time and effort in support of the local community.  The day to day administrative management was done by 1 administrative officer.  The “matron” or in today’s terms, Nurse-manager was also on the ward, working as one of the clinical staff.  Said admin officer had a salary of $50K (approx).  Back then it should be said that the activity of the hospital was also far more, with surgery done, deliveries and even local radiology.  Today, with things run by CHSA, the admin staff at the hospital is 8 with a combined annual salary of $500K (approx).  This while the activity has dropped to basically being an age care facility with a small ED attached.  How does that make economic sense?

So next time you ask yourself where has all the funding gone?  Try looking in the pockets of the bureaucrats.

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