Disabilities of the 1926 System:
For the Patient:
(a) At this time in Darwin, communication with the southern States was limited to one steamer a month. This steamer took about a fortnight between Darwin and Sydney. There being no possibility of successfully conducting a major operation of an advanced nature in Darwin, patients requiring such treatment were under the necessity of journeying south for the purpose. The possibility of a patient being unable to afford either the journey or the delay was an ever-present risk. From its inception, the new medical service set itself the goal of eliminating this necessity.
(b) A large proportion of the people lived in areas remote from medical aid. Communication between Darwin and Alice Springs by road was for the most part a matter of horse transport and between Alice Springs and Oodnadatta camels were used. A patient taken seriously ill in a locality remote from the overland telegraph line – and the vast majority of the rural population were remote from that line – was under the necessity of sending a messenger, perhaps some hundreds of miles by road, to the nearest telegraph station to telegraph one of the Darwin practitioners. If he could make the journey himself, so much the better, but if it were necessary to bring the doctor out to him a reasonable fee might approximate £300, or as much of that figure as the patient could afford. It would be unlikely that the doctor would make the journey unless at least adequate payment for his own expenses was made or guaranteed. For this £300 the doctor might arrive some days after the death of the patient.
(c) Practically all the rural population in the Territory were persons of straitened means, unable to afford private practitioner’s fees of the magnitude that might reasonably be charged by a competent medical officer for services rendered.
For the General Practitioner:
(a) The two practitioners in Darwin conducting private practices could not have remained without the substantial Government salary which was secured to them by virtue of their official positions. On the other hand, the right of private practice meant to them a legitimate increase of salary, and this increase, they argued, should be commensurate with the amount of work involved in rendering the service. The valuation of this service was a matter for their own decision.
(b) The medical practitioner had to draw a hard and fast line between his official and private capacity, and whether by necessity or design his official capacity usually suffered thereby. This led to friction between the Government’s Executive Officer and the private practitioner.
(c) A medical practitioner could not refuse to undertake a long journey on horseback, which might keep him from his practice for many days and cost him a considerable amount in actual outlay and loss of earning power. He had therefore, to make his travelling fee high if only to recover his own expenses, but to the sick and dying in remote localities this minimum fee was largely an insuperable barrier to medical aid. In the case of an aboriginal it could not be considered.
For the Governments:
- The objectives for efficient health and medical service above detailed were difficult of achievement with the assistance of part-time medical officers. These were necessarily rendered immobile by the right of private practice, and their efficiency, from the Government’s point of view, was very seriously limited by the very fact of their being part-time. As a fact, co-operation was found to be impossible,
- Under the private practice system it was impossible for a general practitioner successfully to establish himself in a rural locality such as Alice Springs or Katherine, yet the objectives of the Government demanded that medical officers should be stationed here.
- A substantial subsidy would have been necessary to induce a private practitioner to settle in such places, yet there were obvious disadvantages to the adoption of a plan of subsidising practitioners in all these localities. Whilst Darwin was a pleasant and profitable field, Tennant Creek or Katherine could be deplorable. If the subsidised practitioner were to become tired of his stay in a rural station, it was unlikely that one of his more fortunate colleagues would exchange with him. He must, therefore, leave, taking with him all his local experience, or remain in ever-increasing discontent. Nor would it have been sufficient to subsidise Medical Officers only in rural centres, for this would definitely preclude the prospect of future transfer to Darwin.
Briefly stated, the complicating factors are:-
- Climatic conditions are favourable to the life cycle of various parasites causing or carrying endemic diseases.
- The primitive conditions of life, particularly in rural districts in camps devoid of even elementary sanitation, favour dissemination of endemic and infective diseases.
- The preponderating aboriginal.
- The aboriginal has no system of medicine or practical sanitation in his civilisation. It is incumbent upon the white race directly or indirectly responsible for the introduction of so many new factors of morbidity and mortality to make good this deficiency in the interests of both races.
- The exploitation of cheap aboriginal labour renders such service a matter of economic importance.
- The prevalence of Malaria and Venereal diseases in aboriginals is a perennial menace to the white settler. Contact between aboriginals and foreign carriers of diseases must be controlled to prevent dissemination by the migration of the former.
- The introduction of Japanese, Malays, and Kopangers in connection with the Pearling Industry, furnishes a source for the introduction of endemic diseases for the endemicity of which this country is favourable. New immigrants must be examined and, if necessary, subjected to treatment and kept under surveillance.
- The wide field to be covered, the sparsity of the population, the high cost of transport and the difficulties of speedy communication, all contribute to the difficulty of effective application of measures of sanitation.
- The white population is so small that the cost to the individual obtaining treatment and sanitation supervision is relatively high. Under any other system than that of a national service, whereby the Revenue derived from towns may be devoted to reducing costs in the country, it may be prohibitive. The cost of obtaining a Medical Officer’s services at Anthony’s Lagoon, Borroloola, or Halls Greek, may exceed £500, when a private practitioner must be obtained, notwithstanding that he may arrive too late to render service.
- This difficulty of securing medical attention militates against settlement by women in rural districts, and throws white males into closer contact with the aboriginal, thus retarding moral, physical and economic development and contributing towards the wide dissemination of disease.
- A strong prejudice against the suitability of this region for white settlement still exists in the South. Close study of the acclimatization of the individual for the correction of detected contributory faults in the habits of the community are required. The expenses of such work, unless the medical resources of the country are mobilised, is likely to be prohibitive.