With the bushfire threat high on many peoples’ minds (including Croakey’s), it is timely to consider some of the health issues involved. One of many lessons from the Victorian experience is that health services, especially in areas under-served at the best of times, require extra support for the long-term after such a disaster.

Kristin Michaels is Chief Executive Officer of Eastern Ranges GP Association, which played a critical role in the response to the Victorian fires and their aftermath. It provided medical personnel, mental health workers and general practice support to communities in Kinglake, Marysville, Healesville and the wider Yarra Valley.

GPs and allied health staff worked out of the relief and recovery centres in Yarra Glen and Healesville for more than a month following the immediate crisis, and bushfire counselling staff continue to work with clients at those sites today. Eastern Ranges GP Association received a Recognition of Service Award in the 2009 Public Healthcare Awards in acknowledgement of its contribution to the bushfire recovery efforts.

Here Kristin shares some of her reflections on the past year:

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“The 2009 Victorian bushfires were, without a doubt, tragic, with destruction on a scale never before seen in Australia. It is generally agreed that they are the worst natural disaster in our living history. They were also a target for an incredible outpouring of human assistance and community bonding, and have proved to be the catalyst for significant changes in emergency management policy and planning.

It’s very easy to criticise the decisions made, the services provided (and not provided) and the Government Departments that should or shouldn’t have acted differently. What is important to know is that what we face now is not only the product of those decisions, but is seen through the lens of lives and communities forever changed by what happened on February 7, 2009.

In our little part of the world we are ringed by mountains. Large ones with plenty of bush across the Dandenong Ranges, and those with only blackened bush leading up to Kinglake and over the Black Spur into Narbethong and Marysville. It’s still a very sobering sight to travel those roads and see the now vacant, cleared blocks that once contained homes and families.

Health services have never been an enormous priority for the region. Like most rural areas, the people here consider themselves pretty tough. The bloke who runs the trout farm at Buxton recently told me he’d seen the doctor once, but didn’t really see the need for that type of thing. That ‘type of thing’ was assumedly someone to look after his physical, mental and emotional health.

The general practice that used to service Marysville has been re-housed in Buxton, whilst it awaits a new building in Marysville proper. Recently announced as the Royal Australian College of General Practitioners (RACGP)’s Victorian Faculty General Practice of the Year, the small team at Marysville Medical Centre is propped up by locum GPs funded by the Rural Workforce Agency Victoria. With the locum funding ceasing at the anniversary of the Fires, the people of Buxton may not get the chance to see a GP no matter what their need.

Funding for health in rural communities is always a struggle. We know that significantly less is spent per head in rural areas than in capital cities and we know their health outcomes are poorer, and yet we don’t have the workforce capacity or the population base in many places to alter the inequity.

Once you add a layer of complexity like the aftermath of Black Saturday you have not just individuals, but whole communities in need of health services, in particular mental health services. Commonwealth Government funding to Divisions of General Practice has been limited to provision of psychological counseling services, under existing arrangements with psychologists or eligible mental health workers.

Whilst the State Government has funded its own agencies there has been precious little amalgamation of the two, and many outlying towns still have limited services provided on a visiting or outreach basis. Continuance of the Commonwealth funding has been hard won by Divisions, with the initial contract ceasing on 31 December 2009. Promises of further funding are not yet in writing and have been clearly mooted to cease at the end of June 2010.

The mental health workers who staff the bushfire counselling service report stories of such incredible horror and also those of immense joy. They light up when they speak about the client who made a breakthrough and can now sleep at night, and the one who can look at his children’s pictures again. With up to 40 new referrals being made each month, one has to wonder what will happen to those people without a local doctor or a stable relationship with a trained counsellor.

So as we enter summer 2010 where does that leave health services and their communities?

We face enormous infrastructure and resourcing concerns for the season. Community fear is at an all time high, and risk aversion, already pretty endemic in publicly funded health care organisations, is being operationalised in policies that will see service closures in ‘high risk’ areas, the cessation of outreach services and the depletion of our already limited workforce.

School closures on high risk days force parents to take their leave to care for children. This tends to have a greater affect on women, who make up the bulk of the primary and community care workforce, and subsequently forces closures of care points; aged care facilities, general practices, community health services and home and community care services.

In addition to childcare requirements, people are now advised to leave their homes for four of the six Fire Danger Rating levels provided by the CFA.

So as someone who heads a health care organisation I’ve got to decide how to keep my staff safe, whether to keep my service sites open and my mobile staff at their base site on days rated a very high fire risk and above, and whether indeed any of my staff will actually show up at work (or will show up with kids, cats, dogs, ponies and photo albums in hand), and how I will afford this downtime when most of our service income is derived from Medicare Billing (ie: if you don’t see a patient, you don’t get paid).

Seen through the lens of Black Saturday, we will always take the conservative path, withdraw our services and keep our staff safe. Meanwhile the folk up at Buxton will continue get by. After all, it’s not as though they need ‘that kind of thing’.”

• The Eastern Ranges GP Association is a 200 Member Division in Melbourne’s Outer East with the lowest GP to Patient ratio in the State. Despite the workforce challenges, the Association has experienced significant growth over the past 3 years, with particular expansion in the delivery of services to patients, including 3 after hours medical services and a Patient Services Division delivering over 10,000 episodes of care each year. Kristin was a Finalist in the Telstra Australian Business Women’s Awards in 2008.