Haves and have nots: Inquiry dives into the murky waters of rural and regional health

The child had been sent home from hospital with a diagnosis of asthma.

An 84-year-old woman dies of a chronic subdural hemorrhage after being bounced around hospitals in the Hunter for two and a half months.

She originally attended hospital to undergo a hip replacement.

A woman, who travelled 140km with a twisted bowel, is forced to wait hours for a CT scan in the Central West.

And a man, whose cancer has spread to his brain, is unable to have an MRI at his local hospital in the Southern Highlands.

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These stories are being reflected around the state with the common theme being a health system struggling to keep up with the rigours of modern society, a struggle that will only get worse as we attempt to reopen and live with COVID-19.

These tragic stories have also been highlighted by the ongoing NSW Parliamentary Inquiry into health outcomes and access to health and hospital services in rural, regional and remote NSW.

The inquiry was established on September 16, 2020, following horrific stories told by high profile journalists Liz Hayes and Jamelle Wells about the tragic deaths of their fathers.

The inquiry has held nine hearings, so far hearing from 128 witnesses.

Doctors and nurses to union officials, private citizens, action groups, local councils and hospital management have all come forward.

Most submissions and testimonies outline a lack of staff, increased workloads, long wait times or distances traveled for treatment and an inability to access training for health care workers and services for patients.

In addressing the inquiry's first hearing councillor for the Australian Medical Association (NSW), Dr Shehnarz Salindera, said she herself had recently worked 48 hours without sleep, a trend the doctor says is reflected across the state.

"I was on call in that week for four days straight," she said.

"I provided care during the day, I had elective operating lists in the mornings and emergency operating in the afternoon and I was required to attend the hospital.

"I was called at 11pm and then 12pm and then we prepared the operating theatre. I operated on an emergency surgery at 2am, that surgery took me through until 5am, I went home I had breakfast and I was back at 8.30am.

"We have a problem in rural and regional health in that unfortunately we are often left understaffed because of the metropolitan hospitals prioritising their staffing over the staffing of our regional centres."

In his appearance on May 18, Warrumbungle Deputy Mayor and GP, Dr Aniello Iannuzzi, said downgrades to the level of instruments, the level of beds and services had happened with no communication and no consultation.

"I am talking about basic things that are still in need - basic surgical instruments," he told the inquiry.

"I am not talking about things that are used for open surgery in a theatre. Things like basic suturing equipment so you can repair lacerations, things like instruments to remove foreign bodies from ears, noses and eyes-these are basic things that were there.

"Doctors come in good faith and nurses come in good faith expecting these things and knowing those things are there, and then you turn up to work one day and they are literally gone.

"Instead they give us these cheap and nasty disposable instruments that are very hard to work with.

"I have had situations where patients have come into the emergency department with lacerations and I have literally gone down to my office to bring back decent instruments so I can repair the laceration, or the patient gets sent to Dubbo, or the patient gets sent to the office.

"It is ridiculous that such a thing has to happen, and the same can be said in many small rural hospitals."

Those restrictions don't just relate to equipment with registered nurse Samantha Gregory-Jones telling the inquiry her service often runs out of antibiotics.

"We are stocked by a hospital that is located 30 minutes away from us, we do not have our own pharmacy department," she said.

"We do our own store's ordering, which goes to this location and they send it across. So we can only order on certain days.

"A regular medication we use might be Cefazolin, it is a very common antibiotic which you might just use for a general infection or a laceration or anything.

"We had three patients on this medication and were only allocated from the pharmacy two boxes. That only lasts us one day.

"We had to contact the RNs at this other hospital and get them to deliver it.

"Sometimes it might be a nurse from that hospital driving past us who might drop it.

"Sometimes we have had somebody who is in IGA who we know is in this location pop past and grab it for us because we cannot leave the building to get it.

"Otherwise, if we cannot organise a way, sometimes the courier will bring it the next morning at 1pm, otherwise the patient misses out, unfortunately."

The issues continue from birth through to death, with nurse Pen Mclachlan, saying outcomes can depend on staffing numbers.

"We used to give great palliative care in Condobolin, but now we are just too busy, we do not have that time to spend with the family," she said.

"Recently we were flat out in ED and the ward. A gentleman came in from the local nursing home. He was very agitated. He had a not-for-resuscitation order and that was all fine. He had been incontinent of faeces

"We were not able to give him the time. His daughter and granddaughter were cleaning up his faecal incontinence.

"We then managed to call another nurse, who came in out of the goodness of her heart and took this gentleman to the shower, where he proceeded to die on the bathroom floor.

"The daughter came and said goodbye to her father on the bathroom floor.

"Where do we start to fix it and how do we start to fix it? Because it is a bloody big problem."

Despite this, there are beacons of hope within our healthcare system, like this situation described by Tayla Kennedy.

"I was an inpatient of Dubbo Hospital in 2019. I was due to have my second daughter via elective caesarean and from the moment I walked in I was honestly treated like royalty," her submission reads.

Others praise the tireless work done by local GPs and other allied health professionals.

"Murrurundi has a wonderful GP," one reads.

"The elderly residents like him and feel very comfortable with him."

"We do have a Chemist Shop run by our Pharmacist Tony who does a wonderful job and is very helpful to all of us here," another says.

During the current hearings many professionals express a love for their work.

President of the Rural Doctor's Association of NSW, Dr Charles Evill, said at the inquiry's first hearing rural generalists, " would not do anything else."

"I have just recently done a tour of southern New South Wales in the name of the Rural Doctors Association and spoken to rural generalists who absolutely love what they are doing and who are having a fantastic time and would not do anything else," Dr Evill said.

"I do not want to take anything away from that but, as has been remarked many times, the price of liberty is eternal vigilance and we should not be complacent at all about how we are doing.

"I think this inquiry is addressing some of the areas that we really need to pay attention to."

Or Old Bonalbo Country Women's Association Branch President, Marilyn Grundy, who praised all the efforts health workers had gone too following the closure of the town's hospital.

"I would like to thank and acknowledge all who have provided our multipurpose service after closure of the hospital in Bonalbo," she told the latest hearing.

"We have a good doctor who comes out regularly and stays in the town for three nights.

"He is here four days per week and is fully booked.

"He is available for phone consults, for a script clinic, telehealth and support to emergency department and inpatients at prescribed times."

As we continue to face an uncertain future around how our health system will cope as we return to normality post COVID-19 questions will still need to be answered.

The inquiry continues with six more hearings scheduled through to December this year.