REFLECTIONS ON COVID: The Importance of Local Rural GPs

Rural GPs who live and work in rural communities play a central role in the management of community health, helping to reduce illness, avoid preventable hospitalisation and improve health outcomes for rural and Indigenous people.

During the early stages of the COVID-19 outbreak our dedicated local GPs and practice staff ran drive-through flu clinics, delivered primary care via Telehealth and traditional face to face methods, supported local aged care facilities, ran the local emergency department and supported patients with chronic diseases.

But they were also engaged in a broader range of activities that reflect the central place of rural GP practices in rural and remote communities.

An example of the often unseen work of the rural GP practices was illustrated by the recent work undertaken by Rural and Remote Medical Services Ltd and the staff at its local medical centre RARMS Health working with a local Indigenous community during the early days of the COVID-19 pandemic.

Self-isolation has played a critical role in keeping Indigenous Elders and remote communities safe during the COVID-19 pandemic. But self-isolation has flow-on consequences - how to ensure people continue to have access to essential supplies and food?

This was the challenge confronting the small Indigenous community of Goodooga in outback NSW.

A beautiful little town about 75km from Lightning Ridge on a straight road lined with mobs of kangaroos, three-quarters of the residents are Indigenous.

If COVID-19 spread into this community it would have had a serious impact on a town that has a very high rate of chronic disease.

For many Indigenous communities, COVID-19 is not just a disease but an existential threat to their culture, language and people.

When the pandemic was announced, RARMS was contacted by the local community working group to provide information and advice on how the community could best manage the needs of its residents. Being so distant from major centres, very little information had filtered into the community about how to prepare.

RARMS had developed an information pack on COVID-19 for rural and remote communities, which had become a popular resource with users from around the world (https://www.ruralandremotehealth.org.au/covid19). RARMS was happy to work with the community to help it to develop a community health plan.

The Goodooga Community Working Group decided that reducing unnecessary travel in and out of Goodooga would be an important part of minimising the risk of transmitting the infection.

This meant reducing unnecessary travel for the more vulnerable community members to the nearest large centre of Lightning Ridge.

Lightning Ridge is the home of the Black Opal and is major tourist destination for domestic and overseas visitors to the outback. Limiting the potential for interaction and community transmission was a key goal.

RARMS runs the local GP practice in Lightning Ridge, and provides emergency department services at the local hospital.

For local residents with chronic diseases, continuing to eat well is a critical part of managing their conditions, improving long-term health outcomes and maintaining a healthy immune system as the flu season approached and COVID-19 threatened.

Improving access to information was also important to reducing some of the stress and anxiety that had been created in the community.

While organising shopping is not a typical service provided by local GP practices, maintaining good nutrition and hygiene was identified by the Goodooga community as a priority and the RARMS Health practice in Lightning Ridge was happy to help.

RARMS Health worked closely with the Goodooga community and Khan's Supa IGA in Lightning Ridge to support the creation of a food ordering and delivery service to help meet the local communities' priorities.

Khan’s Supa IGA, the local supermarket operator, agreed to set up a special ordering system for Goodooga residents to shop online to avoid the need to travel to town.

But not everyone in Goodooga had access to a computer or device to access online ordering.

Roslyn Forrester from the Goodooga Primary School and a member of the Goodooga Working Group stepped in and organised access for locals to put in orders online and Khan’s IGA allowed orders to be placed by phone.

Now the only issue was getting the orders to Goodooga, a two hour round trip through some of Australia’s most captivating landscape.

The Lightning Ridge Bowls Club immediately volunteered to drive the shopping to Goodooga, with pick ups organised 15 mins apart to maintain social distancing.

It was a great example of how local communities pull together in times of difficulty to identify issues, define priorities and look after each other using local knowledge and networks.

It's also a reminder of the often unseen role that rural general practice plays in rural and remote communities.

RARMS doctors and staff live in these towns, so they know local residents and the key issues. They are our eyes and ears on the ground to watch out for things that often get overlooked which impact on community health outcomes. Being in the communities enabled us to get information out to the community, as well as communicate to government about priorities.

When members of the community became concerned about the influx of relatives over the Easter period into the community, and the risk to Elders, RARMS asked one of its counterparts in Western Australia for permission to reprint a sign that Elders and other people with chronic diseases could put up on their front doors: "Out Elders Are at Risk - This House is an Elders Protected Area COVID-19". This provided some comfort that visitors would be aware of the risks of direct contact with Elders.

RARMS work didn't just extend to food deliveries and signs. In a partnership with Manildra Group, RARMS organised the distribution of 2000L of donated hand sanitiser when stocks were running low across western NSW.

This was a mammoth effort involving people all the way from the RARMS Practice Manager in Gilgandra to the Rural Fire Service in Sydney, local State Emergency Service, Police, Home Timber and Hardware and Finnemore Transport working together to make sure our most vulnerable communities could continue to receive the healthcare they need.

The supply ensured that local communities, like Goodooga, could access hand sanitiser for the most fragile members of the community and supplies were freely available for local aged care facilities, Police, Rural Fire Service, SES and others to maintain essential services.

And as local rural health services ran out of personal protective equipment (PPE), and sufficient supplies needed by our communities did not materialise, RARMS staff worked together with other local health providers like Wellington Aboriginal Health Service to source supplies and share the cost to ensure the primary healthcare needs of our communities were met.

Distance from major regional centres often means that the voices and local knowledge of remote and Indigenous people get overlooked and marginalised.

This was a key observation made by the Commonwealth Minister for Indigenous Affairs, The Hon Ken Wyatt, following the release of the Closing the Gap annual report recently.

There will be many lessons from COVID-19, but the one that will resonate most in rural, remote and Indigenous communities is the critical need for remote and Indigenous communities to be engaged and consulted about their health to ensure that local knowledge informs the design and delivery of programs and that community needs are met.