While 71% of Australians live in metropolitan areas of Australia1, it is important to remember country people have poorer access to health services, shorter life expectancy, and up to 1.4 times the burden of disease compared to people living in major cities2.
The proportion of people who do not have a specialist nearby increases from 6% in major cities, to 22% for inner regional areas, 30% in outer regional areas, and 58% for remote and very remote areas3.
Growing up in rural Queensland I knew all too well the difficulties country people face trying to travel to the city for a specialist opinion, having to take a friend or family member to drive them, navigating unfamiliar streets and paying for expensive parking.
I myself remember getting my first pair of glasses for myopia when I was 14 from a visiting optometrist to my country town, being able to read car number plates and signs across the street clearly for the first time in years, and just how grateful I was that the running outreach clinic saved us a two-hour return car trip.
Providing healthcare to regional Australia is an important issue, and we can all play a role in reducing healthcare isolation to people who live outside of the major cities. I was working as a vet in the Kimberley when I decided to go back to university to study medicine.
My goal was to become an ophthalmologist and establish a practice in a regional centre. Thankfully all this transpired, and I am now the first full time vitreoretinal specialist in Toowoomba, west of Brisbane, which has a population of around 163,000, and a catchment population of around 300,000 people.
Despite the issues with access to healthcare, country people living in small towns and non-urban areas generally experience higher levels of life satisfaction compared to those living in urban areas4, and have increased community participation, social cohesion and informal support from their communities5.
Working in the country also gives you more exposure to serious pathology and there is the opportunity to work in a shared care model of health care between optometrists and ophthalmologists. This is especially true for diabetic retinopathy screening, with diabetes being more common in outer reginal and remote areas (7%) compared to major cities (5.6%).
Trauma is also 2.5 times higher in rural areas2, and if you work in a rural location you are often the first port of call for emergency presentations. So being available and able to provide specialist medical care outside of the city provides huge professional and personal satisfaction, but it also saves the patient time, stress and the social and economic costs of traveling to the city.
For retinal surgery, I am also able to save patients having to stay in Brisbane for one to two weeks until gas in the eye reduces enough for them to safely travel over the Great Dividing Range, to avoid gas expansion and permanent blindness.
Unfortunately, there is still further healthcare inequality for patients who cannot afford the out-of-pocket costs for private healthcare, which is especially true for ophthalmology.
There are eye surgeons who do outreach clinics in regional centres, but outside of the southeast corner of the state, Townsville and Cairns, there is no permanent public ophthalmology service.
This is disappointing, especially in Toowoomba with such a large catchment area. With time and further lobbying of local health services and state government, funding could be made so patients who are disadvantaged not only by distance but also by finance, can have access to services closer to where they live.
From my perspective, this makes particular sense for urgent and blinding conditions such as retinal detachments, trauma, and chronic conditions like macular degeneration and diabetic maculopathy that can require monthly intravitreal injections of anti-VEGF for treatment.
ABOUT THE AUTHOR:
Name: Dr Andrew McAllister
Qualifications: BVSc(Hons) MBBS(Hons) MMed(OphthSc) FRANZCO
Business: Toowoomba Retina and Eye Specialists
Position: Retinal surgeon and physician
Location: Toowoomba
Years in the profession: 1 year as a consultant, 11 years as a doctor
References
- Census of Population and Housing: Reflecting Australia – Stories from the Census,2016. Australian Bureau of Statistics; 2018.
- Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015 – Summary report. Australian Burden of Disease Study series no18 Cat no BOD21 Canberra: AIHW. 2019.
- Survey of Health Care: selected findings for rural and remove Australians. Australian Institute of Health and Welfare. 2018;Cat. no. PHE 220. Canberra: AIHW.
- Wilkins R. The Household, Income and Labour Dynamics in Australia Survey: selected findings from waves 1 to 12. Melbourne: Melbourne Institute of Applied Economic and Social Research. 2015.
- A Ziersch FB, I Darmawan, A Kavanagh, R Bentley. Social capital and health in rural and urban communicites South Australia. Australian and New Zealand Journal of public health. 2009;33:7-16.
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