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The community is our only hope – editorial

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DR Bushel close up

Dr James Bushell

17 years obstetrics at the Millicent Hospital

and wants to continue.

by S Lowe 5 THE FM’s newsonline wattlerangenow

All Obstetric Services between Murray Bridge and Mt Gambier have been closed now with the recent announcement by Country Health SA, confirming the closure of Millicent obstetric services; a total of 341kms between services. The closure of Millicent Hospital Obstetric services affects people far beyond Millicent .

Mayor Evan Flint, Kingston Council said,” They (CHSA) cut down our services, our anesthetic machine was poor, the doctors weren’t qualified, so they shut down our Obstetrics. They have given no thought the people north of Millicent.”

“Our young mums want to go to Millicent Hospital to have their babies,” he said. “They (CHSA) have done this without any thought for our girls up here in Kingston and Robe.”

“When a town like Millicent, has a service like this cut, what hope have we got?”

Dr James Bushell, Medical Clinic Millicent, has been delivering babies at the Millicent hospital for 17 years, I asked him for his opinion on the closure of Obstetric Services at the Millicent Hospital.

He said, “I have not been told officially that Obstetrics have ceased in Millicent.”

“It was very sudden.”

 “During the Clinic’s contract negotiations with CHSA, I told them that I would be available to deliver at the Millicent Hospital with-out an on-call payment, so funding can’t be the issue.”

“Our difficulty is that CHSA will not pay for Obstetric or Anesthetic  on -call payments, so when we put only one doctor on the on-call roster instead of three, they say we don’t have enough doctors on to do Obstetrics.”

In the past, having an on-call Obstetric doctor meant that if they were not busy with a birth they could be called on to assist in an emergency or if there was more than one emergency at a time – a safer alternative than having only one on call doctor.

Dr Bushell has provided the Millicent Hospital with a roster to cover Obstetrics every day in August and will do this without the on-call payment.

“So, says the doctor with 17 years experience delivering almost two generations of babies in Millicent Hospital, “why close obstetric services?”

“Country Health SA say, Millicent doesn’t have enough doctors to safely and consistently offer obstetric services, but he said, “ I would argue that what we have been doing is safer than none at all. At least we are keeping the services going until we get more skilled doctors.”

I relate the following stories as they were told to me -names and details have been provided to me.

1)After going into labor at home mum-to-be rang the midwife at Millicent Hospital about midnight.  She was told to go back to bed for a while, but rang back shortly after.   The midwife didn’t want to call Dr Bushell. He was not on call. There was no one there who could deliver.

 The midwife told her by the time she was hooked up and monitored at the Millicent Hospital, she could probably be in Mt Gambier, so she was told to go straight to Mt Gambier. It was her second baby.

Her husband drove her to the Mt Gambier Hospital, Dr Charleton was on duty, there were 5 babies delivered that night, her baby was delivered by the midwife at 4-00 am after 2 hours labor.

At 7-00 am the cleaners came in and made her bed. She told the staff that she wanted to go back to Millicent Hospital for her post natal care. She was put in a room in the Mt Gambier Hospital,  no bed just a sofa, no pillow, no blanket and just 3 hours after delivering her baby and having numerous stitches. On occasions a nurse worked nearby at a desk.

“ I tried to ‘curl up’ on the sofa,”  she told me.

The nurse asked once, ‘how are you?’   

“I said, I think this is a real shame, especially as I am a private patient.”

 “I had no help with my baby’s first feed, it was difficult for me to walk because of so many stitches, I had no buzzer to call for help and there was no one to help me.”

Her husband arrived and rang Dr Bushell at the Millicent Clinic to get approval for his wife to return and be admitted to the Millicent Hospital for her recovery.

He drove her and new baby, less than 12 hours old, to the Millicent Hospital.

“ I just don’t know why we did it, it wasn’t safe,” she said, “but I thought I had no other option.”

“My mum said, WHAT, they didn’t even bring you by ambulance?”

 She spoke to us because she wanted people to know, she believes the Mt Gambier Hospital is feeling the pressure of  the additional births, that there are possible communication issues between the two hospitals and it is confusing for expectant women because there are so many variables when having a baby.

 2)A young Kingston Mum had her baby, she could be transferred by ambulance, but the ambulance was not equipped to carry the baby. The young father followed the ambulance with his 4 hour old baby in the car with him. The Ambulance staff from Robe and Kingston, are mostly, if not all, volunteers. The Kingston community is now fundraising for a humid-crib for the ambulance.

 3) A young Millicent mum was sent to the Mt Gambier Hospital to have her baby; had a caesarean section at 2-30 am. Six hours after her caesarean she was sent back to Millicent Hospital with her husband, by car, with her 6 hour old baby. This couple said that the stress they were under on the  trip back was terrible. When they arrived at the Millicent Hospital ‘we were a mess’ they said.

4) Two Millicent mums-to-be have been told they will have to live in Mt Gambier and Adelaide respectively for at least a month before delivering because of their very short labor with first babies, they would not have time to reach Mt Gambier.

 Dr Bushell said ‘ I would argue that what we have been doing is safer than not doing it at  all.”

CHSA have stated often that only 35 babies were born in the Millicent Hospital last year and this is not sufficient to maintain Obstetric Services. How many babies could have been born in the Millicent Hospital, had there been staff provided. This would be a more accurate number to base any decisions on before closing the Obstetrics Services in Millicent and perhaps many of the other obstetric services that have already been closed in regional SA. CHSA Peter Chapman was quoted on the ABC as saying that Millicent women had chosen to deliver in Mt Gambier. This has not been the case with women who contacted us.

A document published by the Rural Doctors Association of Australia said,

“Rural women have the right to choose birthing at hospitals in their own communities supported by their family and friends and continuity of care from their local maternity service. Robust evidence shows that small rural hospitals are safe places to give birth”

“Hospitals, health authorities and health departments may anticipate savings through closing rural maternity units but in broader terms this is not cost effective because among other things:-

Eg: closure (of maternity units)shifts the costs from the health budget to rural families and communities in the form of transport, accommodation, loss of income due to absence from farm or other employment, ambulance services face higher costs, workloads and responsibilities frequently without increased funds, staff or training needs to cover them.

They also said that planning should  be based on community need, rather than predominantly budgetary considerations and an evidence based framework developed in consultation with rural communities and rural healthcare providers is essential.

Dr Bushell said, “We, the GP’s, have not removed any of the services from the hospital but we have had a long difficult time negotiating the CHSA contract and it has been difficult replacing doctors during this time because of the on-going uncertainties. We want to keep Obstetric Services for our paatients in Millicent and would urge CHSA to reconsider.”

“We have exhausted every avenue – the community is our only hope,”   he said.

* A request from CHSA to confirm details of deliveries transferred to Mt Gambier was not available at the timeof posting this story.

2 thoughts on “The community is our only hope – editorial

  1. Without regular birthing at Millicent the local nurses (RN’s) will lose their qualifications unless they move to a Hospital that provides the service, it is my understanding they must perform so many deliveries per year to remain qualified.

    But CHSA has no idea of the implications of their totally hairbrained ideals, all CHSA is worried about is their own payroll bottom line. We can thank Labor for this situation, just another labor stuff up…..

  2. The CHSA representatives put up a pretty effective smokescreen last night at the public meeting and almost had me thinking that the strategy of transferring births to Mt Gambier was in the interests of safety. Of course nothing could be further than the truth. If home births can be Health Department sanctioned in Adelaide, then surely a hospital birth can be safe at Millicent hospital. It’s certainly a lot safer than a backseat delivery or a risky car journey back to Millicent, with a new baby, for post natal care. A little more will, skilled management of staff, but most of all EMPATHY from CHSA decision makers is required. They say they all live in the country, and understand rural life, but I’m not so sure.

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