'I don't have the tools'
COPING is something Dr Daniel Rankmore sees a lot of in regional and rural healthcare.
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When Dr Rankmore spoke to the Leader, Gunnedah Hospital's emergency department had just been without a doctor for four days.
Multiple people were waiting for ambulances to take them to Tamworth hospital, he said.
It's not uncommon for patients to travel across the Hunter New England Health district's (HNEH) network of 27 hospitals to have treatment that isn't offered in Gunnedah.
The district covers a distance of 131,785km square. That's larger than England.
The district had the highest number of emergency department attendances by approximately 30,000 in NSW during the period of July to September 2022, according to the Bureau of Health Information.
Dr Rankmore has been involved in the redevelopment of Gunnedah Hospital - one of many projects to upgrade facilities in the region in an attempt to attract more staff.
He campaigned to get a CT machine in the plans, with no luck.
A CT machine would mean people who need to be transferred to another hospital can be sent with a specific diagnosis, or help determine if they need to be sent elsewhere at all.
Current and projected demand in clinical services planning does not support the introduction of a new CT service, a spokesperson for HNEH said.
Dr Rankmore said he was shown data suggesting Gunnedah only undertakes a few scans a week.
"It's like telling someone that doesn't own a car, 'you don't drive a car, so why would you want a car?'" he said.
"I've written to them and said that one day we're going to make the wrong decision because we don't have the tools we need.
"I feel quite confident in my ability to do my job, but I don't have the tools, and that's more than just a CT machine."
Grassroots push to change 'second-class' healthcare
MARIA Hitchcock has lived in Armidale for nearly half a century.
She spent much of this year pushing a petition to split HNEH, directly employ doctors in rural hospitals and dramatically increase nursing numbers.
The petition, arguing the health district is too large and services end up centralised in Newcastle, has racked up more than 16,000 signatures across the region.
HNEH amalgamated multiple former health districts in 2005 in order to reinvest into improving frontline clinical care, particularly in rural and regional areas, a HNEH spokesperson said.
The individual hospital boards were dumped, and the decisions made for the New England North West have since been made by a board based in Newcastle.
"We have different issues, and we really need to be the ones to decide on the solutions to those issues, not someone who sits in a metropolitan office," Ms Hitchcock said.
"We're always going to be treated like second class citizens."
Northern Tablelands MP Adam Marshall said the district has been a burr under the saddle since it was formed.
"As some of those workforce and service issues have become more stark, there hasn't been any real communication, leadership, solution, new initiatives, from the health district," he said.
Minister for Regional Health Bronnie Taylor has opposed the split, because John Hunter Hospital in Newcastle - the lead referral hospital or base of HNEH - provides services and outreach to smaller hospitals.
"It's a really big issue for a local health district when you don't have a major treatment centre within your district footprint," she said.
"We have to accept that sometimes we are going to have to travel for certain treatments."
Ms Taylor has instead called on the federal government to accelerate the rollout of a model currently on trial in the Central West's Murrumbidgee to attract health staff.
The model employs rural generalist trainees - GPs with skills in emergency care and obstetrics - to deliver free care for the community in both hospital and primary care settings.
The government is establishing up to 10 trials of the model, and NSW will "go into the bucket to try to get as many as we can".
The government plans to seek expressions of interest from across the nation in early 2023.
But for the state to be able to implement the model, exemptions to the Health Insurance Act 1973 allowing public hospitals to bill the federal government for consultations made by a GP working in a hospital must be made.
"It's really important because if the feds don't do it, they're cost-shifting that onto us," regional health minister Bronnie Taylor said.
The model ensures that when people in the community are most sick, that there is a doctor at their local hospital, Northern Tablelands MP Adam Marshall said.
"It's the medicine that we need for our hospitals."
Community safety net
A BAKE sale was the saving grace for severely ill and undiagnosed 12-year-old Eli Whittaker.
A lively, bubbly kid from the moment he opens his eyes, by age five a short trip to the corner shop near his home in Tamworth left him fatigued.
He experienced regular bloating, severe reflux which burned the back of his throat, and episodes of cyclic vomiting throughout the next seven years of his young life, his mother Jade said.
The waitlist for a public health specialist to investigate Eli's symptoms was 12 months long, his mum told the Leader.
Once that year had lapsed, Ms Whittaker was told there was nothing on his file that would warrant him having scopes to investigate his mystery illness.
It was going to take another year.
Eli suffered three hospital admissions in less than six months. The third was severe.
"He wasn't my little boy anymore. It was like he lost that light," Ms Whittaker said.
"I was gonna stop at nothing to have it done."
Recommended a private specialist in Sydney, Ms Whittaker prepared to spend the last $3000 she had in savings to get her son the help he needed.
The family was quickly offered a surgery date, but fell just short on funds.
Ms Whittaker knew she had to come up with the money, pronto.
So, she threw a bake sale.
Cars lined up around the block in Tamworth to support the fundraiser, and the baked goods were sold out within an hour. More than $800 was raised for the family.
The bake sale was thrown on a Sunday, and by the following Tuesday, Eli was in Sydney for his scopes.
"The night that we had the investigations done, once Eli was in bed, I cried," Ms Whittaker said.
"It was a release of all of that pent up frustration, and sadness, and anger."
Eli received three diagnoses within days, and two will be lifelong conditions.
He has regular "expensive" follow up consultations with the doctor in Sydney via telehealth.
It will cost Ms Whittaker $400 to $500 a month for the indefinite future, but without the help of their community, the family would still be facing an unknown illness.
"Eli and I will forever be indebted to the community for what they've done for us," she said.
"And for my little boy, it's changed his life, and we will always carry that with us."
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