Rural healthcare

Send me an angel

Author: Amanda Lyons

Angel Flight allows rural GPs to link patients in remote areas with access to much-needed specialist healthcare.  

People who live in rural and remote areas of Australia often have poorer health outcomes,¹ and the more remote the location, the poorer those outcomes tend to be.²

A key aspect of this disparity is the fact people in rural and remote areas are beholden to issues of accessibility to health services. This primarily takes in dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness.³

‘People in rural and remote areas have told me they simply couldn’t continue [treatment] if they had to drive to larger centres to access facilities,’ Marjorie Pagani, chief executive officer of Angel Flight Australia, a charity that provides rural and remote patients greater healthcare equity through the power of flight, told Good Practice.

‘One lady in rural Western Australia, who was in her mid-80s and driving to Perth, told me, “I can’t do it anymore, I just won’t go to the treatment”.

‘It’s similar if you’ve got several young children at home and nobody to look after them. You’ve got to take them with you on these terribly long drives.’

Such challenges in access, individually or in combination, result in approximately 20% less Medicare-funded GP activity in remote areas despite the relatively high health needs of the population.² In addition, remote Australia has 80% fewer specialists than in major cities.²

Although GPs in rural and remote areas of Australia often practise a wide range of procedural skills to help meet some of these gaps in healthcare,⁴ and can also utilise telehealth and video consultation technology to connect remotely with specialists,² there is often no option but to refer to specialists in metropolitan centres. This can present a significant challenge for patients ‘in the bush’.

Such difficulties inspired the creation of Angel Flight, which has its home base in Queensland’s Fortitude Valley. Founded in 2003, the charity combats the tyranny of distance by flying patients to and from their home and specialist health provider, allowing them to complete the journey in a fraction of the time and save considerably on costs.

‘We fly people from the country into the city for their regular treatment and check-ups,’ Pagani said. ‘It might be dialysis, chemotherapy, obstetrics, anything that requires a specialist trip that isn’t available in the country area. 

‘We try as hard as we can to get them home on the same day.’

Angel Flight is dedicated to the belief that people shouldn’t have to live in larger towns or cities – or have high incomes – to receive equitable access to important healthcare.

‘It saves patients time and money, and some people are not in the ambulance service so they simply can’t afford the travel otherwise,’ Dr Anthony van der Spek, GP and past pilot for Angel Flight, told Good Practice. 

 

Vital transport

People in rural and remote areas can access day-to-day primary healthcare from their local general practice, and emergency medical services from the Royal Flying Doctor Service (RFDS). But non-emergency specialist treatment falls into something of an awkward grey area that can make access significantly more difficult.

Pagani provided an example of this when discussing the case of two pregnant women travelling from a remote community in Western Australia to the larger coastal town of Carnarvon.

‘These ladies were more than 20 weeks into their pregnancies with no check-ups yet because the drive [to Carnarvon] was 14 hours over really rough roads,’ she said.

Accessing specialist healthcare can be especially stressful when it is required on a regular basis.

‘It’s such a strain on families to do these long trips, particularly if the patient has something like chemotherapy or dialysis, which has to be done very regularly,’ Pagani said. ‘The mental and welfare strain of having to undertake those long trips is enormous.’

The fact the flights are provided at no cost to the patient can also be a godsend for many people in rural and remote Australia. Additionally, there is no limit to the number of times a patient can use the service, which is based purely on need.

‘We had one young lady flying from Chinchilla [in south-east Queensland] to Brisbane for dialysis.

She had no functioning kidneys and she flew with us 500 times,’ Pagani said.

As referrers to specialist services, and practitioners with knowledge of a patient’s context and situation, GPs are positioned to play a key role in providing access.

‘If GPs know we’re here, that gives them the opportunity to let the patient know there’s an easier way to access their regular treatment,’ Pagani said.

‘The GP also knows whether that patient can manage to fly in a light aircraft, and whether that person has a need [for accessing care]. That need might be financial or it might be that they can’t drive the very long distance [required for treatment]. And in many of the remote communities, there simply isn’t that regular air transport system.

‘So the GPs are really pivotal because they know who’s out there in their communities who needs help, and they can refer them.’

 

Flying for Angel Flight

The key to Angel Flight’s services is volunteer work, particularly on the part of its pilots.

‘We have around 3500 volunteer pilots,’ Pagani said. ‘They use their aircraft, their time, their skills, and they meet the bulk of the running costs.

‘We reimburse them for the fuel used on the trips, which is about a third of the

cost of running an aircraft.’

Many of Angel Flight’s volunteer pilots enjoy donating their time and have racked up an impressive number of hours in the air on behalf of the charity.

‘We have pilots who have numbers of flying hours up in the hundreds,’ Pagani said. ‘We have one based in Moorabbin in Melbourne who’s flown over 420 missions for us.

‘It’s an amazing effort and, of course, we are unashamedly capitalising on pilots’ love

of flying. And they love to be able to use their aircraft and their skills to help other people, at the same time as doing something they love.’

While it is not necessary for pilots to be medically qualified, there are a few such people who fly for the charity. Dr van der Spek is one such medico-pilot.

‘I thought, “Well, that would be a good idea. I could give something back to people who have problems and use my plane and the skills I’ve developed to help”,’ he said.

A love of flying seems to run in the family bloodline. Dr van der Spek’s father was a pilot during WWII and his son is a pilot for Qantas, while he got his own pilot’s licence in 1977.

‘I’ve seen a lot of Australia with the plane,’ he said. ‘I’ve been across to New Zealand a couple of times along with some friends who own similar aircraft, and around the islands near Papua New Guinea. I’ve moved around a bit.’

Although Angel Flight is used solely for transport purposes and no medical care is provided on the plane, Dr van der Spek believes his training as a GP has nonetheless been helpful.

‘As a medical practitioner, you perhaps understand the passengers’ problems a little better and you can work out if they’re going to have any problems with the aircraft, mobility problems and that sort of thing,’ he said.

For many Angel Flight passengers, the journey itself is vital.

‘Once I had a young boy who had leukaemia and he had to go to the Royal Children’s Hospital [in Melbourne], and he lived in Merimbula [a town on the far south coast of New South Wales],’ Dr van der Spek said. ‘He didn’t qualify for ambulance transport, so it’s a heck of a journey for him, whereas it’s a couple of hours in the aircraft.

‘He was a bright young kid who unfortunately developed the cancer and had to be treated. The family was very grateful [for the service] and I felt great for doing it.’

Volunteer help is not just restricted to the sky, however. The charity also has a network of drivers who meet patients when they land in their designated location. These ‘earth angels’ take the patients from the airfield to their appointment at the hospital or specialist centre.

‘Sometimes that’s the scariest part of a big trip [for the patient],’ Pagani said. ‘They can come in from the country, and then they hit the city and have to get across to the hospital.

‘In Sydney, for example, the Children’s Hospital is not on a train line so it means either hundreds of dollars in cab fares – which most of the patients couldn’t afford – or trying to fight the way through traffic or get a series of buses.

‘It’s very difficult, especially for the elderly people, or parents who sometimes have two or three young children in tow, trying to make your way through a city. And even if you do have a car, parking is difficult and very expensive at the major hospitals. So the drive is really important for them.’

According to Dr van der Spek, registering as a pilot with Angel Flight is a straightforward process.

‘You just get on the website and give them the details,’ he said. ‘You do have to get in touch with them periodically to show them you’re up to date with your medical certificate and the routine checks that you have to have as a pilot. But that’s basically it.’

The process to volunteer in other capacities, as either a referrer or a driver, is similarly simple.

‘It’s very easy to register,’ Pagani said. ‘After that registration comes in for the pilots and the drivers, we ask for some other documents that relate to their qualifications, aircraft recency, all those things.

‘But for the health professionals [who want to refer], they only have to register once as a referrer and then it’s simply “send a flight request”.’

Because Angel Flight doesn’t fundraise in more traditional ways, it relies on community outreach to get its message out to patients and health providers.

‘It’s a volunteer organisation run for the community, supported by the community,’ Pagani said. ‘There’s no government funding, nor do we ask for it.

‘But where we help people in the communities, people get to know about us. Service clubs help us, mayors put on events when they know we’ve been supporting people in their towns. So people help us because they know we are helping their people.

‘The backbone is our pilots and drivers, who are giving an awful lot and love doing it.’

Dr van der Spek has nothing but warm words for his experience with Angel Flight.

‘It’s a great organisation, it’s very much a voluntary organisation,’ he said. ‘[Volunteering is] very rewarding and we all enjoy doing it.’

 

References

1. National Health Performance Authority. Healthy communities; Avoidable deaths and life expectancies in 2009–2011. Sydney: NHPA, 2013.
2. National Rural Health Alliance. The health of people living in remote Australia. Canberra: NRHA, 2016.
3. Russell D, Humphreys J, Ward B, et al. Helping policy makers address rural health access problems. Aust J Rural Health 2013;21:61–71.
4. Paliadelis P, Parmenter G, Parker V, Giles M, Higgins I. The challenges confronting clinicians in rural acute care settings: A participatory research project. Rural Remote Health 2012;12:2017.