SOUTH AUSTRALIA'S HEALTH THEME has been: Building cutting-edge medical knowlege and quality treatment at the top level but struggling with adequate or efficient resources for the public hospital system.
South Australia shared with many other places the 19th Century public health burden of filthy conditions. But the colony managed, through factors such as its medical school and research institute, to keep abreast and contribute to medical knowledge and treatment
The Labor state government in the 21st Century made a leap towards fixing the continuing shortfall of resources in the public system with Transforming Health, centred around a new $2.4 billion Royal Adelaide Hospital. Technical and medical glitches, plus political threats, eroded and ended Transforming Health even before a Liberal government was elected in 2018 on promises of a new approach. Any new transforming-the-transforming approach will be challenged by the added problems of an ageing population and mental health.
As in other areas, South Australian health had its distinctive aspects. One of those was homeopathy in the 19th Century. Homeopathy tied in with the nonconformist Dissenting Protestant Christianity that was a driving force in founding South Australia. This merging of homeopathy and a practical anti-establishment Christianity, concerned about social issues, brought public health to the fore. Allan Campbell, a homeopath but also an officially qualified doctor, led this public health crusade and started the Adelaide Children’s Hospital in 1879.
As homeopathy faded in the 1870s, a new South Australian-born batch of doctors questioned their colonial predecessors and demanded more scientific rigour. This group was the first in Australia to set up official links with British medicine and its advances. They paved the way for an Australian Medical Association. South Australian medicine continues to welcome and learn from its international links.
But always swirling in the background of South Australian medicine and health have been disputes between doctors and government administrators over authority and funding.
ADELAIDE HOSPITAL OPENS NEAR HACKNEY ROAD IN 1841
Adelaide Hospital endured constant squabbles between the board and honorary doctors over authority, overcrowding, unclean conditions and funding in the second half of the 19th Century. In 1867, the board had to deal with allegations the hospital was being used for free treatment by people who could afford to pay. The hospital progressed by setting up its medical school, with Adelaide University, in 1883, but it was embroiled in the most famous of its disputes in the 1890s. The fight deepened when premier Charles Cameron Kingston became involved and it became complicated by personal matters.
Calvary Hospital at North Adelaide and Wakefield Street Private Hospital – original parts of what would become the 21st Century second largest private health care provider in South Australia – started in 1883. Parkwynd (1915), Memorial Hospital (1920) in North Adelaide, Ashford (1935), ad St Andrew’s (1936) and Burnside War Memorial Hospital (1943) are other surviving private and community hospitals. One of the early non survivors was the German and British Hospital, opened in 1850 in Carrington Street, Adelaide. Burnside War Memorial Hospital started in Toorak Gardens' most extravagant mansion. It was donated free to Burnside Council in 1944 by Otto George Ludwig von Rieben.
The governor's wife Audrey Tennyson led the push to get South Australia’s first maternity hospital in 1902. Premier Frederick Holder refused government money but Tennyson secured land on Fullarton Road, Rose Park, from the South Australian Company and £500 from Robert Barr Smith. The biggest opposition come from the medical profession whom Tennyson criticised for being “furious at losing a few fees”. Tennyson oversaw what opened as the Queen's Home but eventually became the Queen Victoria Hospital.
19th CENTURY CONCERN FOR CHILDREN IN APPALLING CONDITIONS
One of South Australia's earliest preventative public health initiatives was a quarantine station on Torrens Island. It was proposed as early as 1850 and was operating by 1855 as a tent city. Isolated at the Port River mouth, Torrens Island was ideal for a quarantine station, enlarged in 1879. It could be reached only by launch or barge and had its own power, water and sewage. In 1886, insanitary conditions at Adelaide Hospital meant mattresses were taken to the quarantine station and disinfected.
Helen Mayo pioneered maternal and infant health and welfare in South Australia and Australia. After matriculating at the Advanced School for Girls (later Adelaide High School) on Grote Street in 1895, she became the University of Adelaide’s second graduate in medicine in 1902. She topped her class and won the Davis Thomas scholarship and Everard scholarships. Mayo spent two years working in infant health in England, Ireland and India. Returning to Adelaide in 1906, she starting a private practice and worked in honorary roles at the Adelaide Children’s Hospital and Adelaide Hospital. In 1909, Mayo addressed an interstate conference on South Australia’s high infant mortality rate and argued the need to educate women for motherhood. Later that year, she and Harriet Stirling (the daughter of professor Edward Stirling) founded the School for Mothers in a small clinic in Franklin Street, Adelaide. Despite criticism that spinsters couldn’t teach mothers, the organisation flourished from a cottage in Wright Street, Adelaide. The school became the Mothers' and Babies' Health Association (MBHA). By 1927, it had branches throughout South Australia and a training school for maternal nurses. The MBHA eventually became part of the state health system. Because Adelaide Children’s Hospital wouldn't admit infants aged under two, Mayo and her group in 1914 rented a two-storey St Peters house as a hospital for infants. Mayo set up strict anti-infection protocols for what later became the 70-bed Mareeba Hospital, run by the state government at Woodville.
CHILDREN'S HOSPITAL AMONG SPINOFFS OF 1860s HOMEOPATHY PHENOMENON
Dr Henry Wheeler had his qualifications questioned by the South Australian Medical Board in 1862 because he also practised homeopathy. Yet homeopathy was part of medical reform against "orthodox" treatments such as using leeches. The reform wanted a shift to public health to help the poor.When Dr Allan Campbell joined Wheeler's practice in 1867, they set up the Adelaide Homeopathic Medical Charity, funded by wealthy donors, to offer medicinal help to those unable to pay.
TUBERCULOSIS AND THE MAKING OF THE MEDICAL PROFESSION FROM RUGGED RAGGED START
As the heyday of homeopathy passed in the 1870s-80s, a new generation of mainly Australian-born Adelaide doctors wanted with a more scientific approach to medicine. These included Edward Stirling who returned to Adelaide in 1881 – after graduating from Trinity College, Cambridge, and being admitted to the Royal College of Surgeons – to help found, with Joseph Verco, the university's medical school. They and others, including William Gosse, George Mayo, Thomas Corbin, John Davies Thomas and William Hayward, set off a movement that would ultimately lead to the first annual general meeting of the Australian Medical Association (AMA) in 1962 at the University of Adelaide.
The Verco dynasty – started in 1840 when young stonemason James Crabb Verco arrived in Adelaide – became a major influence on South Australian medicine and dentistry. James Crabb Verco’s' fourth son, Joseph Cooke Verco, went to London to study medicine. He returned to Adelaide in 1878, coinciding with the rise of the new university. In 1885, with Edward Stirling, he helped found Adelaide University's medical school and was pivotal in setting up the university's dental school after World War I. Robin Warren, 2005 Nobel medicine prize winner, is part of broader family that contains other notable Adelaide names including Margarey, McMichael and Ludbrook.
ANOTHER ONGOING PROBLEM FROM START OF COLONIAL SETTLEMENT
Parkside Lunatic Asylum was nicknamed “The Bin”: a dumping place for those who didn’t fit into society. It opened in 1870 during some mental health enlightenment. Patients were no longer chained up or put in baths to be cleansed of the Devil. Syphilis-related dementia provided up to 20% of patients through to the 1900s. In 1915, Parkside’s population was 1,157. (It peaked in 1958 at 1,769.) Overcrowding was normal with hallways used as wards. It was called Parkside Mental Hospital from 1913 and Glenside Mental Hospital from 1967.
Hundreds of mental health patients were still waiting more than 24 hours for treatment in the state’s hospital emergency departments in 2016. SA Health’s July 2018 target was that 90% of mental health patients would not wait more than eight hours. The Sout Australian Mental Health Commission was launched in 2015. With one in five South Australians experiencing mental illness, the commission advises on government services such as education, employment and housing.
SOUTH AUSTRALIA'S PUBLIC HEALTH SPENDING AT $5.9 BILLION IN 2015
The extensive and controversial Transforming Health system was announced by the Labor state government in 2015 with the slogan “Best Care. First Time. Every Time”. The system was designed to trim $900 million off the state's $5.9 billion annual health budget, with federal funding not expected to rise greatly. Transforming Health aimed for a two-tier metropolitan hospitals system, with the new Royal Adelaide Hospital, Lyell McEwin Hospital at Elizabeth and Flinders Medical Centre on the top tier.
The Labor state government's Transforming Health project became a 21st Century battleground of state politics. In the health system, criticism of Transforming Health, feeding constant media attention, was led by the SA Salaried Medical Officers Association (doctors working in hospitals), Nursing and Midwifery Federation, Australian Medical Association and individuals such as Warren Jones, a Flinders Medical Centre emeritus professor. The government's biggest department, SA Health, was charged with bringing in Transforming Health. SA Health took over from South Australian Health Commission, created in 1975, that replaced the Hospitals Department. SA Health had 26,942 medical staff and 13,590 administrative workers in 2015 in the Central Adelaide, Northern Adelaide, Southern Adelaide, Women’s and Children’s, Country Health SA local health networks (LNHs) and SA Ambulance Service.
Advances in 21st Century South Australian health knowledge and procedures benefit from a complex mesh of links between universities, research precincts, hospitals and private industry – with the local mesh extending nationally and globally. Adelaide’s biomedical research precinct on North Terrace integrates health knowledge from hospitals, the South Australian Health and Medical Research Institute and the three Adelaide universities. The buildings in the precinct are dominated by the $2.4 billion new Royal Adelaide Hospital. Fundraising foundations attached to the Royal Adelaide, Queen Elizabeth, Women’s and Children’s and Flinders Medical Centre hospitals generate millions of dollars for research.
CHANGE OF STATE GOVERNMENT IN 2018 PROMISES CHANGE OF PUBLIC HEALTH STRATEGY
The new Royal Adelaide Hospital, opened in 2017 with a transfer of patients from the east to the western end of North Terrace, was central to the Transforming Health vision as a super site for treating major accidents and emergencies such as heart attacks and strokes. Aside from early glitches including a power outage from a software failure and ongoing overcrowding and workspace problems in the emergency department, the hospital brings significant overall improvements to patient care.
Modbury Hospital, serving the north-eastern Adelaide suburbs, will regain a high dependency unit under the Liberal state government elected in 2018. This reverses the Transforming Health move to downgrade Modbury’s emergency department’s 24/7 care to non-life-threatening cases, with the hospital concentrating on becoming a centre of excellence for elective surgery. The Liberal government said it would also restore surgical capacity and upgrade emergency services at Modbury.
The Liberal state government, elected in 2018, axed $200 million plans for the Repatriation General Hospital’s Daw Park site and said it would reopen it as a genuine health precinct. The hospital’s shutdown had been the most emotive part of Transforming Health, with some war veterans protesting outside Parliament House for months. Ward 17 at the hospital closed in 2017 with complaints that its one-stop services plus general surgery – would be lost. The Liberals promised to reopen five operating theatres.
PERSISTENT PROBLEMS AMONG CONSTANT IMPROVEMENTS
SA Health’s EPAS (Enterprise Patient Administration System), an electronic health record of patient history, has run into schedule and cost blowouts (from $220 to $500 million) and patient safety concerns. The incoming Liberal government paused the rollout of the system in 2018. EPAS, besides replacing paper records, also aimed to be a single state-wide system unlike in Victoria, NSW and Queensland where individual hospital systems cannot talk to each other.
In a sector often battling for resources, South Australian country centres are gaining health services through advances such as more interns, telehealth and mobile dialysis units. In 2019, the numbers of junior doctors training in country South Australian hospitals will more than double to 12. A telehealth video conferencing network is bringing instant extra expertise to Country Health SA’s 64 regional and remote hospital across the state. Fifty-seven haemodialysis chairs in country centres allow more people to receive lifesaving treatment closer to home.
South Australians have the worst dental health of mainland states, according to the 2018 Medibank Better Health Index. In South Australia, 32.3% of people have at least one dental problem, above the national 30.4%. Tooth decay is suffered by 16%, above the national average and only better than Queensland. A year’s wait for public dental and eye treatment is common. In 2016, waiting times more than a year across most of South Australia's public health system and as long as 17 months in the state's south east.
21st CENTURY PUBLIC HEALTH ADVANCES
South Australian women aged between 70 and 74 will continue to receive free biennial mammograms as part of the BreastScreen Australia program, as part of $4.2 million agreement in between the state and federal governments in 2018. More than 90,000 South Australian women have free screening mammograms each year at BreastScreen SA. South Australia has some of the best breast cancer and cervical cancer screening rates in Australia. For those aged 50 to 74, the rates have been measured as the highest in the country at 58.4%, well above the national average of 53.7%.
The Royal Adelaide Hospital is the only place in Australia where people suffering severe and hereditary pancreatitis can have potentially lifesaving islet auto-transplant surgeries. For 10 years,The Hospital Research Fund has given more than $1.5 million to renal transplant research and ground-breaking islet transplant research. Meanwhile, the survival rate for premature babies in South Australia keeps improving with a 2015 report showing there were 35 neonatal deaths, at a mortality rate of 1.7 per 1,000 live births. These are two examples of the positive side of South Australia's healthcare and the skill and work of its clinicians, researchers, nurses, support staff and fundraisers. Outstanding staff achievements, projects and innovations are highlighted in the annual South Australian Health Awards.
South Australia became the first Australia state in 2018 to introduce a free vaccination program for babies and young people against the potentially deadly meningococcal B disease. There have been 372 cases of meningococcal B disease in South Australia since 2000, including 14 deaths, and more than 60% of those affected were aged under 21. Against the national trend, the disease has not declined in South Australia over that time. South Australia was up with national benchmarks for immunisations generally in 2017 with nearly 94% of five year olds vaccinated.
BEYOND SOUTH AUSTRALIAN PROBLEMS WITH EVERYDAY SERVICE DELIVERY
A man who suffered serious burns to 95% of his body received world-first treatment at Royal Adelaide Hospital Adelaide in 2019 after doctors were able to grow his skin in a lab. Glenn Ogg was injured in a house fire in South Australia's mid north and then spent only nine days in intensive care at the hospital. His treatment involved two cutting-edge technologies developed in Adelaide by the hospital's burns unit director and 2016 South Australian of the Year John Greenwood. The first technology, biodegradable temporising matrix (BTM), is a skin dermal replacement and involved immediately removing Ogg's deep burns – 85% of his total body surface – and then applying the treatment. The second technology was to grow composite cultured skin in the laboratory. To grow the skin over about five weeks, a graft was taken from Ogg's scalp to create 26 pieces. BTM holds the burn wounds healthily and improves them during the five weeks it takes to grow the skin.The composite cultured skin was applied to 50% of Ogg's body surface and the rest was covered by standard grafting. Ogg then had surgeries to completely close his burn wounds. Despite having no skin and only BTM in his wounds, Ogg took his first steps in hospital just 28 days after the fire. Greenwood began researching the two techniques after becoming distressed by patients with injuries so severe they couldn’t be treated. Patients with burns to more than 80% of their body usually don’t have enough unburnt skin that can then be used for skin grafts. A clinical trial of the cultured skin technique has begun at Royal Adelaide Hospital.