Hospitals across the Riverina have seen a widespread decline in services, with noticeable staffing issues creating barriers to care and leaving volunteers to fill gaps in the healthcare system, a state inquiry has heard.
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Doctors, healthcare staff, councillors and volunteer groups from across the region appeared before a regional and rural healthcare inquiry on Wednesday. The committee was set to hold sessions in Tumut and Wagga, but moved proceedings online due to the COVID-19 pandemic.
Gundagai GP Dr Paul Mara has worked in the region for decades and said there is a medical workforce and service "meltdown" across the Riverina.
He said that both the Commonwealth and state governments have spent millions, if not billions, of taxpayer dollars over many years on policies that have failed, and organisations that have not been accountable for outcomes.
"All small towns across the country should be asking the question: where has the money gone?" Dr Mara said.
"It seems that with the money spent we could have sent a person to the moon, but not a doctor to Hay."
Leeton Shire Council mayor Paul Maytom said the community feels "vulnerable" with the current level of services and is "not asking for anything unrealistic", just "basic treatments that save lives".
He told the committee of a Leeton man who fell ill at home and whose son called an ambulance, but decided to drive him to Narrandera Hospital when he "could not wait any longer" and "had no faith" that Leeton Hospital would have a doctor on-call.
"It seems that with the money spent we could have sent a person to the moon, but not a doctor to Hay."
- Dr Paul Mara
Narrandera mayor Neville Kschenka said the centralisation of services in Wagga and Griffith is creating barriers to treatment, mainly around travel.
He said the constant need to transport patients can lead to an overload in Wagga and take ambulances away from towns in the case of emergency.
The council's community transport service has had to step up, with mainly volunteers providing more than 10,400 patient trips as of June this year.
"Our trip numbers are up 50 per cent on the previous year ... so the need is definitely growing," Narrandera Shire Council general manager George Cowan said.
Currently there are five people from Narrandera who travel to Griffith three times a week for dialysis, utilising community transport for the whole-day journey.
"We have approached Murrumbidgee Local Health District about the possibility of having a chair or two installed in the hospital here, there's plenty of room, but the response we get back from them is that it's a staffing issue," Mr Cowan said.
Linda McLean from the Hillston Country Women's Association branch said that travel for healthcare can often lead to people travelling for upwards of four hours.
She said that patients from Hillston will be taken to Griffith Base Hospital for assessment, and from there transferred to Wagga Base. If Wagga has no free beds, they will then be taken to Albury.
Travel concerns were echoed by Stacey O'Hara, a committee member on the Murrumbidgee Aboriginal Health Consortium, who said community members in remote areas often don't have the means to travel 300km for treatment.
"Even those in paid employment often have exorbitant living costs and must prioritise whether or not accessing medical treatment is more important than feeding the family or registering the car," she said.
Cr Maytom said he feels "to some degree helpless" as mayor around the issue of healthcare.
"It is mind-boggling to me as mayor to lead this community and I can't answer the questions," he said.
"We're not seeing that real transparency we need to see [to] give us a clear indication of what really is happening."
Cr Maytom is eager to work more closely with the MLHD on improving services, and hopes to see more "transparency" from them in return.
"[People] must prioritise whether or not accessing medical treatment is more important than feeding the family or registering the car."
- Stacey O'Hara
"We don't know at any time if we go to the hospital ... is there going to be a doctor there to service the needs of our community," he said.
"Our community should be told and should be aware when we don't have a doctor available."
Dr Mara told the committee there are three pillars to ensuring sustainable medical practice in a country town: proper infrastructure to practice in, enough staffing to reduce workloads and on-call time, and adequate remuneration.
He also said a solution to the current crisis is the Murrumbidgee Rural Generalist Training Pathway, a four-year contract allowing a transition between hospital and community-based placements.
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"It starts to create a new paradigm of service delivery, employment, industrial relations and flexibility," Dr Mara said.
The fact that only 15 per cent of medical graduates want to do general practice points to a "fundamental structural problem", he added, with incentives needed to get more graduates in the bush.
"We shouldn't be talking about GPs in the bush ... we should be talking about rural doctors," Dr Mara said, with this distinction hopefully encouraging more people to take up employment in the rural areas.
Ms O'Hara said it is vital to create culturally safe health facilities for Indigenous people across the region, including the recruitment of Aboriginal staff.
"In hospital it doesn't have to be the cleaner or the cook, start having some reception staff - frontline staff - that when Aboriginal people walk into a building they feel a lot more comfortable," she said.
John Fernando, chairperson of the Riverina Murray Regional Alliance, is advocating for a cultural recovery and healing centre based on Country, offering AOD programs and mental health services.
He said there is an AOD service in Wagga, but it has a four-month waitlist and is not culturally safe, with patients having to travel 240km to Cowra for culturally appropriate care.
"If we are able to get this [centre] up and running and on Country, we can start pulling those vacancies with local qualified people who have been through the system, and now they work on Country and support their family, friends and their relations," he said.
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