What happens when a community is denied access to general practice?Dr Sue Velovski argues that if the Government’s failure to support Lismore health providers is a social experiment, then the results are in.
This article first appeared in the NSW Doctor in January 2023.
Most of us born after 1970 in Australia do not know life without the privilege of universal healthcare – the ability to see a doctor irrespective of our financial status.
Our healthcare system ranks as one of the best in the world and is praised by the citizens of many other countries… even Presidents. I recall being at a conference in San Francisco in 2011, when the then President Barack Obama spoke to a group of Aussies about our experience of healthcare.
I was fortunate to be born in this country, a first generation Australian. This allowed me access to free healthcare and the ability to complete public high school, and with the benefit of scholarships, complete university. In a world where one-fifth of all girls are denied an education, this is not something to be taken for granted.
My parents had immigrated from the former Yugoslavia as children. One of six kids, my dad came on his own as a teenager, while my mother came when she was 14, emigrating with her family from Macedonia in the 1960s.
In three months upon arriving in Australia, mum learnt to speak fluent English. She became the unofficial interpreter for many Macedonian immigrants in Newcastle and beyond.
In the 1970s, my parents married and settled in Newcastle where they continued to help those in need in of a translator.
Consequently, as a child I would spend many afternoons after school sitting in little chairs in corridors at Royal Newcastle Hospital with my twin brother doing our homework, whilst Mum and Dad attended various clinics with their friends, work mates and family. I would watch the young doctors come in and out of consulting rooms, call out names, and wonder what happened behind closed doors. I would see patients in gynaecology clinics, surgical clinics and even patients admitted to hospital. Some happy patients, some scared, and some sad. Trips to GP practices were different, however; we were allowed to sit in the doctor’s office. The ‘family physician’ knew all the patients’ families and would ask about them by name… he would even ask about us.
Why do I recall this now?
Because I have never lived a life without a GP in Australia. Because my community has never been without a GP.
And even when I’ve travelled or lived in other parts of Australia, my family physician has always been there to keep me healthy and safe. My family doctor provided health checks, vaccinations, shared in the ups and downs of my schooling, my university training, and then my medical school life. My family doctor was also there throughout my parents’ health journey – the good, the bad… they helped with it all.
So, what would life be without a GP? I have never had to ponder that question… until now.
When Lismore sustained two life threatening and damaging floods in the space of 28 days in February 2022, never would I have thought that our community would still be looking for help and answers from our elected leaders almost a year later.
Most Australians would be aware of the impact of the floods, the loss of homes and of jobs and job security, and the financial strain. But perhaps many are unaware of the anxiety and constant concern we face in trying to get through the next day, week, month.
And like everyone else in the community, our rural and regional GPs face similar stressors. Many are affected by personal loss, the loss of their medical practices, and the loss of their ability to work on top of the increased pressure to see and treat their long-standing patients, as well as new ones.
What happens when a patient with high blood pressure or irregular heartbeat who usually sees “Dr Jo” in Lismore for their medications cannot not do so?
Days, weeks, months later, they develop the complications of not seeing their GP – mini strokes, vision loss, heart attacks. They end up in a State-funded hospital for major interventions, which may or may not restore the better life they had before they developed these complications.
What happens when a patient with diabetes in Lismore cannot see “Dr Lisa” for their regular diabetes checks? High blood sugar, changes in vision, car accidents, increased risk of foot ulcers, infections, amputations, strokes, and heart attack. They end up in a state-funded hospital for major interventions, which may or may not restore the better life they had- before they developed these complications.
What happens when a patient was booked in eight weeks ago with “Dr Liz” in Lismore for a skin check but rings to say that a new skin cancer has grown rapidly from 1cm on the arm to 4cm? Dr Liz schedules the patient for an emergency GP visit, but soon realises this cancer is now well beyond being treated in her GP clinic. “Dr Liz” rings her local on call specialist surgeon and is advised that there is a three-month wait. The emergency surgeon recognises how dire situation is and has no other choice but to bring the patient to hospital. The patient ends up in a state-funded hospital for major interventions, which may or may not restore the better life they had.
When happens when a patient cannot see their GP for their regular bowel screen? Months pass, then bleeding, constipation, abdominal pain and then vomiting. They end up in a state-funded hospital for major interventions, which may or may not restore the better life they had.
What happens when a community surviving a natural disaster cannot clean their houses or get help from their long-time insurance companies? Like good hardworking stoic citizens, these community members do it themselves. The consequences being work injuries, falls from scaffolding, lead poisoning, anxiety, depression, and a feeling of hopelessness.
Not just adults, but young people as well are facing increased mental health issues. Many young teenagers did or will be doing their HSC from caravans. How can these young men and women possibly compete with the rest of their peers to reach the goals they held before February 28, 2022? Should their future be determined by their postcode and Mother Nature’s rampage on that area?
What happens when all of these patients who face complications because they were unable to see their GP end up in state-funded hospitals? The hospital system gets overloaded and cannot provide high quality, safe care. Bed block, overcrowding in emergency departments, lack of beds for cancer surgery, delayed surgeries, expensive surgical and oncological treatment, increased numbers of patients experiencing physical and mental breakdown, doctor burnout – all of which could have been avoided if our patients had only been able to see their family GP.
In my not so long life, I have experienced and lived through earthquakes, cyclones, bushfires, and now floods.
In response to other natural disasters, the recovery started quickly and occurred rapidly.
But the response to floods has been different. Lismore is still not “in recovery”.
We cannot change what has happened to Lismore in the last 12 months. But we must make changes so that that no other community in NSW or Australia experiences the same lack of access to their general practitioners and specialist services due consequences of a natural disaster.
The Commonwealth and the State must take responsibility, which at this point neither level of Government appears willing to do so.
The inaction of leaders on this matter defies Article 25 of the Universal Declaration of Human Rights that we, as Australians, hold so close to our hearts – that people have a right to medical care. That we boast to former Presidents about…
Resolving this issue would save our Commonwealth and State Governments money, not increase it.
We need a coordinated response from State and Commonwealth Health Departments, so that no other community in Australia experiences the social injustices of natural disasters, and the social injustices of the inability to see our GPs when we need primary care… care that keeps patients out of hospital and keeps residents healthy.
We cannot leave our communities with the belief that our elected leaders do not care. As a first-generation Australian who has benefited from public education, scholarships, public healthcare and now working in the public healthcare system, I cannot sit silent on the health and wellbeing of our communities. We are a nation that allows free speech, without detriment or harm to our constituents, but for that privilege, we must speak up when it is needed, for those who feel they cannot.
We must resolve this impasse between Commonwealth and State Health leaders for our community, our patients and all those who have previously considered rural Australia a great place to work and live. These people, and these GPs, are the backbone of our communities.
If our elected leaders want to see what life is like without GPs, then Lismore is the “social experiment”.
I call on Prime Minister Albanese to put an end to the Lismore experiment and prevent it from ever happening in any part of Australia ever again.
ABOUT THE AUTHOR
Dr Sue Velovski is a Specialist General Surgeon in Northern NSW – Lismore / Ballina and Board member of Nordocs.
The Rural Doctors Association of Australia awarded Dr Velovski the Rural Doctor of the Year Award in 2022.