The hours preceding Libby Davie’s arrival at the Perth Children’s Hospital are a blur.
All she remembers is sitting numbly in a car during a long drive through the night.
But what she does recall, all too clearly, is a moment earlier that afternoon when her sick baby was bundled onto a Royal Flying Doctor Service (RFDS) plane.
She stood on the Esperance Airport tarmac and prepared to follow when a nurse turned to her and asked, “How are you getting to Perth?”
“And it became very apparent I was not going with my two-week-old baby.”
Two months later, she said the experience showed the incredible stress medical evacuations often caused country people.
She wonders whether that can be reduced by investing in more health resources across remote and rural Australia.
A stressful experience
On October 19, Ms Davie’s daughter Elly developed a cough that impacted on her ability to breathe.
She was admitted to the Esperance Hospital Emergency Department and put on oxygen.
After three nights, it was decided she would be flown to Perth with the Newborn Emergency Transport Team (NETS) on the Royal Flying Doctor Service.
Ms Davie said she was only told she could not accompany her daughter on the plane at the very last minute.
“I was like, ‘Who is going to feed her? Who is going to settle her?’,” she said.
“I just went really numb.”
An RFDS spokesperson said it would soon add another seat to the Pilatus PC-12 aircraft for a parent to accompany the NETS team.
With no commercial flights until the next day, Ms Davie said her only option was to drive 700 kilometres to meet her daughter in Perth.
Luckily, her partner was able to go too, and they left their other toddler with grandparents.
“But in another instance, a hysterical mother jumping in a car with potentially a toddler to drive seven hours?” Ms Davie said.
“[That’s] incredibly unsafe and I hate to think what could possibly happen.”
Ms Davie was reunited with Elly in a hospital ward at about midnight.
While Elly had now recovered from what was believed to have been bronchitis, Ms Davie said the stay in Perth was stressful and expensive, and she wondered how other mothers with fewer resources coped.
“Even just to get a doctor’s appointment, it is outrageous,” she said.
“We must be wasting so many resources flying these people out when they could be in their own home.”
This week another Esperance patient, 77-year-old Dianne Furniss, was flown on the RFDS to Perth, but then had to take another RFDS flight to Bunbury because there was no bed for her in Fiona Stanley Hospital.
Heavy reliance on RFDS
The RFDS is revered across country Australia for the countless lives it has saved.
But data shows it has been relied upon heavily in recent years — in 2021-22 it flew 45,374 aeromedical retrievals, a 23 per cent increase since 2016-17.
RFDS federation executive director Frank Quinlan said that was partly because the pandemic restricted many people’s access to primary care.
But he also believed country Australians needed better access to primary healthcare in general.
“It … does beg the question about whether we’re ultimately spending enough on the sorts of supports and the sorts of services that rural and remote Australians need,” Mr Quinlan said.
A 2022 RFDS report said it expected aeromedical retrieval services would “continue to be in high demand throughout the next ten years”.
That will come at a significant cost — with an average RFDS flight between Perth and the Pilbara, for example, costing $30,000 — and much of the service’s funding coming from taxpayers.
In November last year, the federal government provided $482 million over five years to the RFDS, to deliver primary care and aeromedical evacuations in “areas where normal medical infrastructure would otherwise provide patient services”.
The RFDS received another $29.1m over two years in the most recent budget, along with contributions from the state and other donors.
Support needed for rural GPs
Rural Doctors Association of Australia president Dr Raymond Lewandowski said the RFDS was often needed because of inadequate access to primary care.
“What happens in rural areas is people have difficulty getting care for diseases early in the course, and difficulty accessing preventive care,” he said.
“And so often will present much sicker and further along in their disease than they should be by right.”
But he believed investing in more rural generalists — a specialist field for GPs working in rural settings — could help reduce RFDS flight numbers in the future.
Dr Michael Livingston, a rural generalist who works at clinics across WA’s Mid West and Great Southern regions, agreed.
“I think [continued RFDS reliance] is more a sign of the lack of investment into rural and regional areas when it comes to primary care, and supporting doctors who actually make the move to come to these locations,” he said.
He said during his recent six-week stint at Lake Grace, a small town in WA’s Great Southern, the RFDS only came once, as opposed to multiple times a week before he got there.
But he believed the profession was undervalued and struggled to attract the government and community support necessary to entice people into the field and keep them there.
“The more that we don’t see support, the more that we don’t get acknowledged, the more and more of us will step away,” Dr Livingston said.
“[And the RFDS] will probably find themselves busier and busier doing patients who really would have benefited from good primary care.”
Government making healthcare investments
A federal Department of Health and Aged Care spokesperson said it was investing in the healthcare workforce by tripling Medicare bulk billing incentives, by increasing funding to help practices hire health practitioners, and launching a two-year trial program for international medical graduates.
The spokesperson said it was expanding an employment pathway for junior doctors who wanted to be rural generalists, funding a new Primary Care Nurse and Midwifery Scholarship program, and investing in a strategy to entice former nurses back to the workforce.
The RFDS’ Mr Quinlan said improving access to primary care in the bush was critically important.
“People in those remote and rural locations get sicker than their city counterparts,” he said.
“They die earlier than their city counterparts.
“And a lot of that death and illness is avoidable if we were able to get better primary healthcare to people.”
