Sunday, 7 April 2019

Doctors in rural areas

of Downunder face challenges that other general practitioners do not. They often have to work alone. They need some anaesthetic and obstetric skills their city colleagues are not expected to have. They need surgical skills and much more.
It is little wonder they are in short supply out there.
When I was born my parents lived in a small rural town north of the city. It was big enough to have a small hospital and I and two of my three siblings were born there. After I arrived my maternal grandmother came to "help" my mother for a short time. When my siblings were born my paternal grandmother came to care for me and then my brother and me until my mother was permitted to come home with Middle Cat. In those far off times women were expected to remain in hospital at least a week after birth. In rural areas it also meant that women did not go home to an isolated farm  immediately after a birth. That was probably no bad thing.
It's different now. It is unlikely that a hospital bed would even be available. Any doctor would be agitating to get a healthy woman home because the bed would be needed for other purposes. The growth in rural services simply hasn't kept pace with the need.
And other things have changed too.
When we moved to the tiny place where my parents had the two teacher school my mother was just returning to teaching full time. She was required by law to undergo a medical examination so we all went to the nearest doctor. That was a one hundred and twenty kilometre round trip. 
My mother had made an appointment - or so she thought. She had rung and spoken to someone who said, "doc's out. I'll leave a message. If it's not convenient he'll get back to you." That was the way things were done. 
When we arrived he was there - doing something to the plumbing outside. He heaved himself out of the trench looked at my mother and said something like, "You better come in. Can't do it out here."
We later heard tales about this man. We met the man whose life he had saved doing what was effectively open heart surgery under the light of car headlights and lanterns on the side of the road. We heard about the time he was stopped by the police for speeding on his way back from the city. His response was apparently "Get out of my b......way. I've got a patient dying back home and I'll go as fast as I need to save him." (This was reported not by him but by his passenger - somebody he had taken to the city for urgent treatment.) The police let him go. 
There were other stories too. He made no secret  of the fact he had no time for my mother's Christian Science beliefs. He could be rude and was often abrasive. He was a man who was under stress although we children would not have understood that. 
Now the same town is twice the size and they can't get a doctor to stay. They have tried offering free accommodation. They have offered more staff and equipment for the tiny hospital. Doctors don't want to go. The pay isn't good for the hours and responsibility involved. The insurance for potential litigation is too high. A fly in fly out doctor once a week earns $2000 a day - when they can get one. 
All sorts of things have changed. Yes, a doctor can get back up help via computer and video link if the system is working but they need skills that can take  years to acquire - and they have the costs that go with it. Medicine is much more complex and demanding. There is a great deal more paper work. There are far more rules and regulations about what can and cannot be done.
The doctor back then dealt with mental health issues in his own way.  He prescribed things other than pills to help his patients. He would "drop a word" to the priest or the minister or the football coach that someone needed a bit of extra time or help. Breach of confidence? Perhaps or perhaps not - but people were getting support they needed. Now it could not be done.
Perhaps that is one reason why it is so difficult to get doctors in the bush now. But, if you know anyone who wants to take on the responsibility, then let them know please. There are vacancies in the bush.

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