COMMONWEALTH OF AUSTRALIA
DEPARTMENT OF HEALTH
CUSTOMS HOUSE, SYDNEY
31st JULY 1930
Dear Dr. Cumpston,
In reply to your letter of the 23rd instance asking for my comments upon the Frontier Medical Service proposal of the Australian Inland Mission, I submit her a few reflections on the matter which I hope may be of some service to you.
The Objective as stated is definite enough, and may, at least as far as North Australia is concerned, be regarded as a statement of the Government’s existing policy. In my opinion, as far as that Territory is concerned that policy can best be pursued along the lines already laid down in North Australia where a satisfactory procedure has been evolved after careful consideration of the problems involved and where any change of an experimental nature is hardly justified.
The Plan is very vague and doubtless is intended to be so. Its various proposals may best be considered under heading given in the A.I.M. memorandum.
- Establishment at suitable bases of Aerial Medical Service Stations.
Under existing conditions in the country served I am personally of opinion that such stations are largely an unjustifiable dissipation of public funds. They are provided upon the assumption that an occasional life saved (or presumed to have been saved) warrants the disproportionate cost on the ground of:
- The value of human life;
- The feeling of security engendered in the local population.
The first ground is one which I do not care to debate, being purely a matter of sentiment rather than one of practical application.
The second I hold to be illusory. The type of individual who takes up his dwelling in these neighbourhoods is unlikely to be influenced by such considerations of security in illness even if justified. In my opinion moreover they are not justified. Cases of extreme urgency are not common and in the majority of those occurring, owing to the availability of motor transport, the proximity of medical aid, the lack of direct telephone or telegraphic communication or other variable factor, the provision or otherwise of such a luxury as a flying doctor is a matter of relatively little practical importance. On the Barkley Tableland of North Australia, the flying doctor is almost invariably regarded as an expensive futility by reason of the fact that is it usually quicker to transport sick persons to Camooweal by car than to wait until a message can be conveyed to the flying doctor of Cloncurry. It cannot be disputed that aerial transport is in certain cases more desirable than motor transport by road, but I content that expensive special provision in this direction is not warranted. There is now an established weekly air mail route between Cloncurry and Daly Waters and taxi planes are available along the route and at Anthonys Lagoon. I am of opinion that the occasional case of immediate necessity could equally well and much more economically be served by the local medical officer using the mail plane or chartering a taxiplane by which procedure the necessity for an annual guarantee to Qantas based upon minimum mileage at taxi rates would no longer obtain and the use of planes in cases of trivial disorder-in order to liquidate the subsidy would be discontinued. Any hypothetical advantage to be gained by engendering a local sense of security should be effectively achieved in this manner.
Furthermore the lay misconception of medical necessity has latterly manifested a definitely undesirable trend in policy. Based upon the erroneous assumption that the first and principal function of a Medical Officer in these regions is the treatment of the dangerously ill, and recognising that available funds will not permit of the maintenance of an Aerial Medical Service and the Queensland Government has decided to close Rural Hospitals and discontinue the subsidy of local Medical Officers. Such a course would in present circumstances be the only possible alternative to abolishing the Aerial Medical Service as at present constituted, and I hold the view that this fact is recognised by the protagonists of the Aerial Medical Service. Were the assumption upon which it is based, a sound one no objection perhaps need be raised, but I think that it is beyond dispute that by far the most important function of a Medical Officer in these regions is that of hygienist to the white and coloured population. True this is an aspect that has been given scant consideration in the past but of recent years in the Territory at any rate an effort has been made to attack prevailing disease at its origin rather than to limit activity to ameliorating the lot of surviving victims. The very nature of the work requires that the Medical Officer shall be specially trained or experienced and subject to co-ordination with his colleagues. No single Medical Officer based upon Cloncurry as the centre of a circle having a radius of 300 miles and liable to calls from every township in that zone could hope to effect that control of endemic and epidemic disease which the problems of the district demand, yet the cost of maintaining and transporting such an officer upon clinical work alone would not be less annually than the retention of permanent officers at strategic points in the district. Event at the present time with Medical Officers in all townships the annual cost of the Flying Boat or approximates £4,000. I think it indisputable that the retention of specially trained Medical Officers is infinitely preferable to the proposed scheme of centralisation and aerial ambulance transport as the magnitude of the field would sooner or later result in simultaneous calls, disputes of priority and the duplication of the service. My point is that if the aerial service is to supplement the existing system there are more economical methods of effecting its purpose. If it is to replace the present organisation it is undesirable and uneconomic.
(2) Co-ordination needs no discussion. The necessity for co-ordination not only in the clinical aspects of Medical Service but also in its Public Health phases is self evident, but in view of what has been said above I submit that the scheme of coordination should be that already adopted in the Territory – by a Government Service financed by benefited contributors.
(3) Frontier Association. It is proposed to finance this enterprise of doubtful utility by organising “some form” of Frontier Association by membership of which citizens residing within benefited areas might receive benefits on terms within their means.
As vaguely stated this appears a sound and practicable proposition. In point of fact I think it is both illusory and actually undesirable. At least half of the population of the benefited area may be considered to live in the towns most of which are at present struggling to maintain Medical Officers and Hospitals. It may be taken as a sine quo non that the bulk of the people in the base township being not benefitted persons will fail to subscribe. The onus of supporting this costly scheme will fall therefore, apart from Government subsidy, upon the few persons at present struggling to maintain small District Hospital and a local Medical Officer. This would mean that either the scheme would fail ox resources would have to be mobilised by terminating existing local services in favour of centralisation. Centralisation by which I mean reduction of staff is to my mind highly undesirable in this area either from the clinical or hygienic standpoint.
Twelve months’ experience in North Australia has shown that subscriptions of £5:4:0 for a married man provide sufficient revenue on a voluntary basis to reduce the extent of Government Medical Service subsidy to a point below the £2 for £1 basis, with every prospect of shortly covering all expense, whilst the objective of free service is achieved. I think it certain that the proper organisation of the Medical Service in the adjoining parts of Queensland would enable townships to retain their own Hospitals and Medical Officers. The expense of subsidising a duplicating Aerial Medical Service is unnecessary an the substitution of the existing local medical and hygiene services of an expensive and discontinuous Aerial Medical Service is undesirable.
In any case the extension of any such Frontier Association into the Territory is to be deplored. Difficulty has been experienced in in enrolling persons from Victoria River into the Medical Benefit Fund of North Australia, those persons arguing that they are already expected to contribute substantially each year towards the A.I.M. Hospital at Victoria River – itself largely already dependent upon Government subsidy. It is certain that any attempt to launch such an Association in North Australia would react adversely upon the development of the Administration’s current policy which promises to be at once more economical and more effective than the alternative effort towards the same objective for the financing of which the Association is to b formed.
(4) & (5) Communication and Landing Grounds. Every encouragement should be given to the improvement of communication and the preparation of landing grounds but these should be essential preliminaries to any projected Aerial Service rather than concurrent activities.
(6) Post Graduate Study. The desirability for this concession to Medical Officers in remote parts of Australia is “beyond dispute. I hold, however that the concession “be made as much in the interests of the employer as of the employee, and I cannot find myself in accord with the scheme which Rev. Flynn outlined to me, nor do I favour any scheme which:
- Favours newcomers to the service of remote North Australia arid Queensland to the disadvantage of those who are present working there;
- Removes any Medical Officer from the Service before the expiry of three years’ service, since the conditions of the Territory demand at least 12 months probation before a Medical Officer can be considered efficient;
- Does not give the Service the benefit of post graduate training – either by reduction in salary prior to the privilege or by requiring return to the Service for a proportionate length of time subsequent to it
Finally I hold that the objective stated is already the policy of the North Australia Administration in respect of the Territory and the system of medical service evolved towards the achievement of this objective being founded on practical experience and a close study of its problems may confidently be expected to prove more effective than any such vague alternative proposal as that in the A.I.M. memorandum.
As for the neighbouring parts of Queensland the disabilities of such township as Camooweal and Burketown cannot be disputed, but in my opinion their interests and the interests of Territory as well will be best served by extending to them the North Australia system thereby enabling them to retain their local Medical, and Hygiene facilities at a cost to themselves and to the Government no greater than would be entailed in the replacing them by the less efficient but more spectacular Aerial Service. For practical purposes in the few cases of real urgency where prompt transport is indicated, I consider it would be much more economical and quite as effective for the district Medical Officer to use available aerial transport for which special arrangements could be made with the Companies concerned.
On the matter of the extension of the North Australia Medical Service to Camooweal, I have already addressed the Department of Home Affairs (1929) and my views generally upon interstate co-operation are already known to you.
I have not had time to collect facts and statistical data, but have confined my remarks to generalisations in the same tenor as the draft proposal. Should you consider the matter warrants further consideration, I shall be glad, later to substantiate my views by statements of facts.
Yours faithfully,
Cecil Cook
Chief Medical Officer
North Australia