Packing up his car for another arduous journey, Paul Lane is spending his precious final years travelling long distances to get treatment for the pain caused by terminal liver cancer.
The 47-year-old was diagnosed in November and he and his wife make the two-hour drive from their Moura home in central Queensland to Rockhampton, 168 kilometres away, every two weeks for scans and immunotherapy.
With record high fuel prices, it's an expensive trip for the couple, who are unable to work and rely on fortnightly carer and Centrelink payments to survive.
"It makes life really difficult for us," Paul's wife Vicki Lane said.
"It can cost us $140 in one week to drive to and from Rocky. It's just an expense that's ridiculous."
To make matters worse, there has been no local general practitioner in Moura for weeks, with residents resorting to telehealth appointments or driving 65km to Biloela.
Moura, with a population of about 1,800 people, had two permanent doctors, but they both left at the end of 2021, leaving the community to rely on locums.
Over the past few months there have been periods of more than 10 days without a local doctor.
It makes it incredibly difficult for Vicki, who is not only caring for Paul but her two children with health needs as well.
"When you think, 'Do I need to take my child to the hospital?' but you've only got a nurse there, you haven't got a doctor.
"It's really scary at times too, especially with Paul with his cancer, thinking if something happens to him, if he needs emergency medical treatment."
Paul can do palliative care only via telehealth and gets his pain medication prescriptions faxed to the pharmacy from Rockhampton.
"That can take overnight sometimes, so he's without pain medication overnight," Vicki said.
"It's a continuous stress."
Attracting and retaining health professionals is an age-old problem for rural and remote areas.
Figures from the National Rural Health Alliance (NRHA) show there is a persistent, ongoing maldistribution of health professionals in Australia, where major cities have an ample workforce supply, while rural areas face a crisis.
Both the Coalition and Labor have made identical election commitments to try to lure medical professionals beyond the cities and the Rural Doctors Association of Australia (RDAA) hopes it will be a "game changer", no matter who wins the May 21 poll.
Rural health crisis 'not a new problem'
It's not just doctors who are nowhere to be seen in many regional and rural communities.
The NRHA said there were fewer registered nurses, midwives, pharmacists, dentists, optometrists, psychologists, podiatrists, occupational therapists and other allied health workers.
Its research shows nationwide, rural areas need an additional 21,357 full-time health staff in these professions to match major cities in a per-population basis.
In western Queensland, Michael Mbaogu has worked at the Mount Isa Medical Centre for almost a decade.
Dr Mbaogu said GP shortages were a "perennial problem".
"The doctor-patient ratio in the town is unbelievable, [it is] well below the national average and well below what the World Health Organisation recommends," he said.
"It recommends the doctor-patient ratio should be one doctor to 1,000 patients."
According to Australian Government Medical Workforce data, the Australian average is three and a half doctors to 1,000 patients.
"In Mount Isa, it is one doctor to 3,000 patients [.3 to 1,000 patients] … we are at a crisis point and we have been for some time," he said.
$146m election commitments welcomed
There's no daylight between the major parties' election promises to fix the growing health disparities between city and country.
The Coalition has committed to spend $146 million over the next four years to attract, train and retain rural and regional doctors.
The election pitch includes more money to give trainee GPs the chance to work in private practices and local hospitals, so they can learn specialist skills like emergency medicine and obstetrics.
Labor has promised to match the LNP's commitment if elected.
Rural Doctors Association of Australia (RDAA) president Megan Belot welcomed the election commitments and said it was a relief to see strong support for rural health.
"We are thrilled with the promise of increased funding under a reform of the Workforce Incentive Program for medical practitioners providing quality care to rural and remote communities," Dr Belot said.
"This package of initiatives is the game changer that rural needed and positions Rural Generalism as a premium career choice for junior doctors."
It's the latest in a series of initiatives aiming to fix severe doctor shortages in regional and rural Australia, an issue which has been exacerbated by the COVID-19 pandemic.
Community funds its own practice
Locals in the small Queensland town of Nebo, 93km south-west of Mackay, couldn't wait any longer for bureaucrats and took matters into their own hands.
Federal funding was allocated to build a GP clinic in the town in 2011, but it struggled to attract a doctor and sat empty for two years.
A GP business was set up in 2013, but within a year the community was back in the same position.
"It was pretty disappointing, we all wanted to have a doctor here," said Joy Cooper, president of the Nebo Medical Action Group and local paramedic.
The group fundraised for equipment and a GP from a nearby town opens the clinic once a fortnight.
"Everything that's in that building at the moment is community owned through fundraising and community grants," Ms Cooper said.
"We've just had a couple of big raffles to replace all the computer systems."
She said locals shouldering the weight of the town's medical future showed the need for governments to do more.
Sarina doctor Awal Rajendra has been travelling to Nebo since 2015 and knows all too well the difficulties of rural healthcare.
"It's not a new concept for me, I have done outreach clinics in Fiji where I'm from," he said.
He sees up to 30 patients each trip and demand keeps growing.
Dr Rajendra said he loved it, but it was the community's active fundraising that kept the clinic afloat.
"When we initially came, we had a masquerade night … we must have raised $3,000 or $4,000," he said.
According to the 2016 census, Nebo has a population of 753 people.
Flow-on effects
Back in Moura, pharmacist Craig Fell says having no local GP means residents are turning to him for advice.
"We find it very hard. We can't refer people to a doctor, as there is no doctor," he said.
"So, we're having to deal with a lot more of health matters that we normally wouldn't see, or even having to try and refer people out of town to other doctor practices because they require a doctor.
"If it comes to the point where we can't provide prescriptions from a doctor here locally, and we have to keep referring our customers to Biloela … this pharmacy might become unviable and that would be a service that this town would lose."
Moura has a population of 1,786 people, according to the 2016 census.
Solution in sight
Moura Hospital Community Advisory Group chairperson Debbie Elliott said two new doctors had been appointed to the Moura Dawson Medical Practice, but they didn't have start dates and it was reliant on locums in the mean time.
Ms Elliot said a locum had started in the town this week, but they were working two weeks on, one week off, which still left the community at risk.
"We've had extended time without a doctor in town, which is just unbelievable for the community," Ms Elliott said.
"It is really good news to know that there have been doctors appointed … but there's still time that needs to be covered."
