Introduction by Croakey: It is well known that Tasmanians generally have poorer health and poorer access to quality health services than people on the mainland.
However, two trends – the growth of adventure sports in remote areas and the migration of mainlanders to affordable housing in remote communities – are adding urgency to the need for effective health solutions, writes Dr Dennis Pashen, a GP on the West Coast and a clinical professor at the University of Tasmania.
Dennis Pashen writes:
“Rural and remote” seems like an oxymoron in Tasmania, which is relatively small compared with some other jurisdictions, and has a population of only half a million. However, there is a significant difference when driving between “mainlander miles” and “Tasmanian miles”.
Whilst the road between Hobart and Launceston is well prepared and can be travelled at normal open road speeds, it is a different matter when driving to the West Coast from either of these centres.
It can take the best part of four hours to drive the 250 kilometres, weather permitting! The roads are winding, prone to snow and ice in winter, rain and obstructive animals the rest of the year.
The health of the populations that inhabit rural and remote communities in Tasmania is significantly poorer than of their mainland equivalent, except for the really very remote Aboriginal communities.
This has become complicated by ageing mainlanders with multiple co-morbidities who have migrated to these rural and remote Tasmanian communities, attracted by the relatively cheap land and housing.
These communities often have lower educational and socioeconomic status, lower health literacy, a higher incidence of smoking and alcohol consumption, and mental health complications. They also experience a lack of continuity of care, poorer access to allied health, mental health, and specialist services. Often locum and agency services are tasked with patching up chronic workforce shortages.
Add to all this is Tasmania’s distracted and metrocentric health system.
This is a guaranteed recipe for a downward spiral in health and services to rural and remote communities.
Now we have adventure tourism starting to boom in the remote communities that are least able to cope with the health consequences.
Mountain biking, white water rafting and cross country trekking – all part of the attractive Tasmanian experience – bring travellers to these communities that are ill prepared to cope with the traumas associated with these economic initiatives.
In just a few months, the West Coast is due to open three new Black Diamond mountain bike circuits, the most difficult available, on top of other circuits in Queenstown, Zeehan and Rosebery.
In the north-east of Tasmania, the impact of mountain biking in Derby, St Helens and Maydena – with less challenging courses – has been significant for the rural health facilities and staff who have to deal with the patients suffering injuries and serious trauma.
Maydena has recently reported on the ABC breakfast show (on 9 March) that they have about two broken collar bones a week. Other centres have had fractured ribs, compressed spinal fractures, and head injuries.
Rural facilities have difficulty attracting experienced staff. There are only intermittent allied health services, if any at all; there is a paucity of mental health, drug and alcohol, pain management, geriatric and palliative care services. There is a deficiency in investigative resources, radiology, ultrasound, pathology – all of which are essential to diagnosis and safe management of trauma cases.
Dare I mention to the Tasmanian Government that “duty of care” may be an issue here?
Whilst no one expects to have access to CT Scans and MRI in smaller communities, there are no clinical pathways for trauma such as occur in these circumstances. Things can be missed with plain X-rays and ultrasound.
Clinical judgement is often the only course for rural doctors, who cannot find the invisible or masked injuries with current locally available investigations. This takes experience and clinical acumen developed over years.
Compounding these concerns is a lack of public transport and ambulance services.
We can expect that retrieval services for additional trauma, on top of the usual acute presentations complicated by the poor health status, chronic disease and multiple co-morbidities of rural Tasmania, will be overwhelmed from time to time.
Is the Tasmanian Government prepared to provide additional resources such as personnel and equipment, twin-engine helicopters, fixed wing retrieval services, additional intensive care ambulances and staff to meet these health needs of their rural communities in areas such as the West Coast?
These are all expensive choices that need to be considered in ensuring the safety of the rural communities and their visitors.
What about telehealth?
There have been discussions about the implementation of telehealth to assist rural communities’ access to healthcare. I have been fortunate to work in States such as Queensland and Western Australia where a well set up and functioning telehealth system has operated for over a decade.
This is not the case in Tasmania, where there is a lack of fit-for-purpose equipment, rooms and access points for rural facilities to specialist clinics and tertiary Emergency Departments for rural telehealth linkups.
If doctors and nursing staff in emergency rooms can link from Fitzroy Crossing or Birdsville or Mornington Island to the Directors of Emergency Departments in Perth or Mt Isa or Townsville or Royal Brisbane and Women’s Hospitals, why can’t this be implemented in Tasmania?
Why can’t Tasmania organise links between St Helens or Smithton or Flinders or King Islands, or Rosebery/Queenstown with Launceston General, Royal Hobart or NW Regional Hospitals?
What are the costs? Less than one air retrieval per site to set up!
It was hoped that the COVID-19 pandemic would facilitate the implementation of such services and to an extent this is the case – but not to the extent that would make this a regular and facilitated option.
What is the organisational torpor that acts as a barrier to such a simple and cost-effective solution?
These are not untried and risky solutions. They are well implemented, frequently used and researched options.
Tasmania has an excellent resource in the Australian Antarctic Division operating out of Kingston, with fully functional and effective telehealth options which are used on a day-to-day basis. If services can be provided to Macquarie Island, Davis and Casey Bases from Hobart, why not elsewhere in Tasmania?
These are simple questions that deserve answers.
Professor Dennis Pashen has 40 years’ experience working within rural and remote practice, mainly in Queensland, and is a former President of the ACRRM. He moved to Tasmania in 2014.
Update on 16 March: Croakey has asked the Tasmanian Health Minister to respond to the article and to these questions: