Women’s pro­gram fly­ing high

Af­ter nearly 10 years of op­er­a­tion, a fly­ing women’s health ser­vice is go­ing from strength to strength, re­ports Adam Cress­well

The Weekend Australian - Travel - - Health -

AMEETA Pa­tel thought she knew what poor ac­cess to health care’’ meant af­ter liv­ing for 41/ years in Alice Springs. Like many out­back towns, even quite large ones like Alice, med­i­cal and, in par­tic­u­lar, spe­cial­ist ser­vices can be lim­ited and over­sub­scribed.

But af­ter sign­ing up to pro­vide fly­ing women’s health vis­its as part of a com­mon­wealth-funded pro­gram, she re­alised even that was only half the story.

The women out there are amaz­ing — they are re­ally stoic,’’ says Pa­tel, a GP who works as a med­i­cal ed­u­ca­tor as well as in private prac­tice.

They put off things and try and fix them them­selves. They are not at the doc­tor’s at the drop of a hat, un­like a lot of peo­ple in ur­ban ar­eas.’’

Once a month, Pa­tel trav­els to Ten­nant Creek, where she stays overnight and spends two days pro­vid­ing a women’s health ser­vice.

Al­though the town al­ready has two GPs, both of them are men— and many women are less com­fort­able con­sult­ing a male doc­tor for var­i­ous con­di­tions, par­tic­u­larly those of a sex­ual na­ture or which re­quire an in­ti­mate ex­am­i­na­tion.

Pa­tel’s vis­its are part of a na­tional pro­gram, orig­i­nally launched by the Howard Gov­ern­ment in 1999, that was de­signed to ad­dress this prob­lem, by fly­ing women GPs into re­mote ar­eas where pa­tients had no ac­cess to a fe­male doc­tor.

De­spite her years of prac­tice in Alice Springs, Pa­tel says she was sur­prised at the need’’ she found in Ten­nant Creek for her ser­vices, since she joined the Rural Women’s GP Ser­vice (RWGPS) pro­gram about 18 months ago.

I have done about 100 Pap smears in that time, and there’s very con­sis­tent feed­back I get that they ap­pre­ci­ate the ser­vice,’’ Pa­tel says.

Al­though Pa­tel has di­ag­nosed some pa­tients with non-gen­der-spe­cific con­di­tions, in­clud­ing di­a­betes and coeliac dis­ease, the main fo­cus is on women’s is­sues. As well as re­pro­duc­tive health, and the pro­vi­sion of im­plantable con­tra­cep­tion, prob­lems that pa­tients want to raise in­clude mat­ters such as in­con­ti­nence.

But men also turn up to the women’s GP ser­vice, al­though in lesser num­bers.

In some cases, men don’t like con­sult­ing an­other man about sex­ual or men­tal health prob­lems, such as erec­tile dys­func­tion or de­pres­sion. In other cases, men go not be­cause the visit­ing GP is a wo­man, but be­cause she is visit­ing — and there­fore the con­sul­ta­tion is more anony­mous than it oth­er­wise would be in a small town.

Since its na­tional roll-out in 1999 the pro­gram has been op­er­ated by the Royal Fly­ing Doc­tor Ser­vice of Aus­tralia, which won the orig­i­nal four-year, $8.2 mil­lion Com­mon­wealth con­tract. The RFDS has also had the con­tract suc­cess­fully re­newed since then for two more four-year pe­ri­ods.

John Setchell, gen­eral man­ager of health ser­vices for the RFDS’s Cen­tral Op­er­a­tions branch, says the clin­ics have proved pop­u­lar with sev­eral groups, in­clud­ing nurses and other health work­ers who would rather see a visit­ing GP in pref­er­ence to the ex­ist­ing, per­ma­nent male GP — who might be their boss, or the per­son they saw ev­ery week at the bowl­ing club, or their hus­band’s golf part­ner.

As the ob­vi­ous ben­e­fits to pa­tients, and the doc­tors who signed up to pro­vide the clin­ics, some other spin-off ben­e­fits had also been iden­ti­fied as a re­sult of the pro­gram.

In a num­ber of lo­ca­tions the pres­ence of the fe­male GP pro­gram has re­sulted in that lo­ca­tion feel­ing con­fi­dent and be­ing able to suc­cess­fully re­cruit a per­ma­nent fe­male GP,’’ Setchell says.

In South Aus­tralia and the North­ern Ter­ri­tory (alone), prob­a­bly three rural lo­ca­tions (have done that) — it doesn’t sound many, but get­ting doc­tors out to rural lo­ca­tions at all is im­pres­sive.’’

At the start of the pro­gram in May 1999 there were 138 lo­ca­tions iden­ti­fied where clin­ics would be held, a num­ber that has since grown to 294.

Rules dic­tate where the clin­ics can go. There must be an ex­ist­ing male GP in the town, to en­sure con­ti­nu­ity of care; there must be a pop­u­la­tion of at least 1000 in the town or its sur­rounds; and the near­est fe­male GP must be over 50km away.

At the mo­ment there are 83 fe­male GPs who pro­vide clin­ics as part of the pro­gram, most of whom are in private prac­tice in ur­ban ar­eas al­though some are RFDS em­ploy­ees. In 2006-07 they saw 15,450 pa­tients dur­ing 984 sep­a­rate vis­its.

Even when it was an­nounced the pro­gram was greeted with en­thu­si­asm by GPs, no doubt be­cause the scheme has made ev­ery ef­fort to avoid an­tag­o­nis­ing doc­tors who are al­ready in the field. Setchell says there would be noth­ing worse than to set up a sys­tem where ex­ist­ing male GPs felt their patch was be­ing in­vaded’’.

For­mal eval­u­a­tions, done both in­ter­nally by the RFDS and ex­ter­nally by the fed­eral health de­part­ment, have also re­turned con­sis­tently good re­sults. The find­ings sug­gest 87 per cent of pa­tients found the visit­ing fe­male doc­tor ex­tremely im­por­tant to them.

When asked to rate var­i­ous as­pects of their at­ten­dance at the clinic, 81 per cent were

ex­tremely sat­is­fied’’ that their health needs were met, 80 per cent were ex­tremely sat­is­fied with the ex­pla­na­tion of treat­ment and 81 per cent were ex­tremely sat­is­fied with the fol­lowup ad­vice.

Nell Sproule, who has been the co-or­di­na­tor of the pro­gram for about a year, says the re­sponse from women is as­tound­ing’’.

Women ring up, and they stop me in the street, thank­ing me,’’ she says.

But de­spite the good feed­back from doc­tors and pa­tients, Setchell says one prob­lem has been the chang­ing avi­a­tion en­vi­ron­ment, par­tic­u­larly soar­ing fuel costs. In the last con­tract rene­go­ti­a­tion process, for the fouryear con­tract that be­gan a year ago, the over­all fund­ing for the scheme rose to $12.6 mil­lion — enough to al­low each of the four RFDS sec­tions to add an­other two lo­ca­tions to their clinic list.

Pa­tel says she will ab­so­lutely’’ keep do­ing the clin­ics due to the pro­fes­sional sat­is­fac­tion it gives her.

Even though I’m go­ing once a month, I’m see­ing women in fol­low-up, and over the year I have seen some women sev­eral times and been get­ting to know them,’’ she says.

I’m hop­ing to be here for a few years at least.’’

Pic­ture: Kelly Barnes

Suc­cess: The pres­ence of the fe­male GP pro­gram has re­sulted in many ar­eas feel­ing con­fi­dent and be­ing able to re­cruit a per­ma­nent fe­male GP

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