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Australia's poorly health service

By Harry Throssell - posted Monday, 22 October 2007


The big issue in this year’s Federal election could well be the sickly condition of Australia's public health system.

While patients with sufficient funds or insurance can access medical advice virtually at will, with the ensuing financial bonanza attracting medicos into lucrative private practice, at the other end of the social spectrum, public hospital patients may be on waiting lists for years, perhaps never seen.

Thirty years ago the legendary Fred Hollows found more cases of trachoma (a preventable cause of blindness) in outback Queensland than in Bangladesh, although it was eliminated from Australia’s non-Indigenous population in the 1930s.

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The Hollows Foundation is now back in action because "Australia stands isolated as the only developed country in the world where trachoma is still a major public health problem", Murray McLaughlin reported on the ABC’s 7.30 Report on 10 October.

Ophthalmologist Hugh Taylor of Melbourne’s Centre for Eye Research heads a trachoma screening program in Northern Territory Aboriginal communities. "It's shocking to find nothing has changed in the last 30 years in these communities", he told McLaughlin. More than 20 per cent of children up to 14 years have symptoms of the infection, caused by living conditions.

Katrina Roper added, "It is a reflection on their poverty, their lack of access to water, lack of basic hygiene, remoteness and infrastructure".

The comprehensive research-based report Social Determinants of Indigenous Health shows Indigenous patients in urban areas often have similar pathology. The common denominator is poverty, not only in the family but also in the wider economic infrastructure, with spiritual and psychological dimensions.

Because of sickness and accidents the average Australian Indigenous life-span is 17 years less than that of the whole population, while compared with the non-Indigenous population it is probably 20 years shorter.

It remains to be seen if Prime Minister John Howard’s new-found love of Indigenous folk during the election period will extend beyond fine sentiments to serious large-scale investment in housing, health, education, training and employment.

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Federal Treasurer Peter Costello announced on 18 September "now with a stronger economy we can begin to improve the health of the nation". Begin? After 11 years in office? The Australian Medical Association called for some $460 million extra financial resources for Indigenous health in the past two Federal Budgets but was ignored.

There is a great need for imaginative solutions to overcome the tyranny of distance to make the lives of patients and medical staff in remote locations more viable. More doctors graduating from universities for a start. Then more investment in light planes, helicopters and other vehicles loaded with modern equipment and supplies to ferry staff and sick patients quickly to and from regional centres.

Big City Hospitals

Jana Horska, 32, who had had a miscarriage in April, took no chances when she experienced cramps after 14 weeks of a new pregnancy so attended the emergency department of Sydney's Royal North Shore Hospital (RNSH) in September.

She arrived at 7pm, was told she was miscarrying, to sit and wait, husband Mark Dreyer arrived, she was in considerable pain for two hours. "Mr Dreyer asked repeatedly for help - but to no avail", reported The Daily Telegraph. When she started bleeding on the waiting room floor she went to the toilet, collapsed, her husband heard her scream and found her "holding a live fetus between her legs with blood everywhere". Only then did she receive help from nursing staff, although Dreyer claimed "she was not cleaned up for another hour".

According to The Sydney Morning Herald this was not an isolated case. Jenny Langmaid was 14 weeks pregnant with her second child when she felt queasy in June 2005. Having had two miscarriages she called a friend to take her to RNSH. She waited one and a half hours, repeatedly telling the triage nurse she thought she was in labour and needed attention. In great pain, she "felt a gush" and went to the bathroom. A baby fell into the toilet.

The Telegraph identified RNSH as one of the most under-funded and trouble-plagued hospitals with problems worse over the past six months:

"There are believed to be up to 100 nursing vacancies ... and internal documents show it had to claw into funding for capital works just to meet its operating budget. The hospital is also frequently choked with ambulances, queued up for hours and sending ripple effects of delays”.

Another woman told the Herald she was bleeding from a miscarriage in early September when staff at RNSH "lost" her in the emergency department, leaving her unattended in a consulting room from 11pm to 8.30am. "My husband rang in the morning ... and was told I had been discharged the night before". It took the staff a further half hour to find her.
When a 91 year-old woman was placed in a supply room all night and the following day at this hospital, NSW Health Minister Reba Meagher told The Daily Telegraph the decision had been made by nurses "for clinical reasons … because the patient was restless".

She rejected any connection between under-funding and poor patient care, claiming "North Shore Hospital provides an excellent standard of service" and the emergency department was not understaffed.

However, Dr Tony Joseph, senior emergency doctor at RNSH, and NSW chairman of the Australasian College for Emergency Medicine, said "When emergency departments are bursting at the seams they will take [patients] and put them in these side rooms [where] they would not receive adequate treatment because they were not equipped with standard hospital equipment" such as emergency call buttons.

Emergency doctor Sally McArthur said on ABC Radio National there was nothing unusual about these events at RNSH, they "could happen in any emergency hospital round Australia … Most hospitals are in crisis … There is a shortage of experienced staff and junior locum doctors are often in charge".

The ageing of the population has led to a predictable 15 per cent increase in presentations at public hospitals.

"Not so organised chaos"

The Queensland Outpatient Review Committee chaired by Professor Ken Donald, Head of the School of Medicine at Queensland University, made some startling revelations in its report of June 2007.

Each of the five hospitals reviewed - Royal Brisbane and Women's, Princess Alexandra, Gold Coast, Cairns, Rockhampton - had a system in which some names on the out-patient waiting lists carried the label "NEVER TO BE SEEN". That is, the likelihood of these patients ever being given an appointment was zero, but neither they nor their GPs were informed.

"It was evident ... Queensland public hospitals are struggling to effectively cope with ... increases in demand resulting from Queensland’s growing and ageing population", the report stated. "Access to specialist outpatient services has not been a priority for Government ... Unacceptable waiting times for specialist outpatient appointments are increasing the risk of adverse clinical outcomes for a significant number of patients, particularly those who are assumed to be non-urgent".

Patients and GPs were not advised of waiting times, innovative models of care have not been widely adopted, and indeed there were references to "not so organised chaos" in some hospitals.

On 1 March 2007 there were 143,900 Queensland people waiting for new appointments, an increase of 18 per cent in a year. However, "the level of funding ... was not commensurate with the increasing rates of demand … resulting in longer and often clinically inappropriate waiting times ... increasing the risk of adverse clinical outcomes for a significant number of patients".

The Committee was alarmed by examples of even the most urgent patients waiting more than 12 months for appointments, some forced to attend emergency clinics.

In March 2007 the co-payment for private specialist services increased 33 per cent compared with 2004/05, while out of pocket expenses increased 150 per cent since 1996. Accordingly, there was an increase in the number who could not afford private treatment and they joined the public waiting list.

The committee recommended all public out-patient services be funded by the Australian Government as a priority.

There was a reluctance to discharge patients back to GPs and adopt innovative alternatives to surgery including physiotherapy and holistic health care. Savings could be made by the use of modern communications, including sending information to distant GPs by email so patients can avoid travelling great distances for brief appointments.

Why do politicians lack interest in public health?

The shortcomings of the public health system do not seem to impinge on politicians' consciousness. Is that because they only use the private system?

Or is there something more sinister at work? Are there Australian politicians who want the public health system to disappear because they believe everyone should pay fees?

This is the theme of Naomi Klein’s The Shock Doctrine, describing in great detail how followers of Milton Friedman and his Chicago School of Economics argue the perfect society is created by having an entirely free-market system for all purposes. No public housing, schools, hospitals, welfare systems, no basic wage, no pensions. She quotes such developments, often short-lived, in Augusto Pinochet’s Chile, Thabo Mbeki’s South Africa, Margaret Thatcher’s UK, and the USA under Richard Nixon, Ronald Reagan, and most of all under George W. Bush and his neoconservative colleagues Dick Cheney and Donald Rumsfeld. The new Iraq is being designed in Friedman’s privatisation image, with US private company security guards increasingly taking over from government troops.

Could Australia’s public health system go down that path?

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About the Author

Harry Throssell originally trained in social work in UK, taught at the University of Queensland for a decade in the 1960s and 70s, and since then has worked as a journalist. His blog Journospeak, can be found here.

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