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The challenges of healthcare relocalisation

Dr Jim Barson is an anaesthetist in Victoria and convenor of the health sector working group of ASPO-Australia. What he writes about in the following article is of central importance to our response to peak oil. Feel free to leave your comments and ideas.

The relocalisation of healthcare is going to be a huge challenge. In the early 1900s local hospitals were dotted all over the map, each at the centre of a circle the radius of which was the length of a hurried trip by horse drawn transport.

When mobility is restricted and if regional/rural areas see their populations start to increase again, the role of the rural doctor is going to have to change greatly. How to plan to relocalise healthcare is just one of many questions that arise from the impact of peak oil on healthcare.

What level of complexity will we be able to sustain 2, 5, 10, 20 or more years into the period of energy descent that will follow on from Peak Oil?

What will be the appropriate level of complexity that balances cost effectiveness with the best possible outcomes?

Almost all drugs are petroleum derived, they represent an extreme case of value adding and without doubt will continue to be made, but at what cost and in what volume? How strong and how stable will the international logistical chain be that delivers them? How many drugs do we need? What can we dispense with? What can we make locally?

What sort of equipment is indispensable? Can it be maintained without recourse to exotic spare parts? What is the minimum needed in an operating theatre?

Is there a case to be made for surgical teams to move around to perform elective surgery in smaller hospitals? If so what can we pack up and move from place to place as required? Should we look at the robust, combat zone/disaster relief surgery/anaesthesia kits that have already been developed?

The present trend to throwaway almost everything is unsustainable. What reusable equipment can we manufacture that will safely do the job of disposable products? What operations and treatments are no longer going to be possible or affordable or justifiable?

We will need to manage risk and accept risk-benefit trade offs that might be currently unacceptable. Is legally driven decision making still going to be a viable response to risk minimization? We can’t really eliminate all risk now and will be much less able to do so in the future.

Will GPs, particularly in rural areas, find that they are called on to do much more and more complex procedural work for patients who can not travel to large centres? How will they get the required training?

We need to counter the dangerous and naïve assumption that natural and holistic therapies will be able to simply take over when conventional medicine starts to fail, with no diminution in health or safety. Some natural therapies that actually work will find a place, but we must fight to defend the enlightenment and insist on scientifically proven treatments.

We must try our hardest to keep the system functioning and adaptable for as long as possible. I am trying to get my head around these issues and would appreciate input from others who are thinking about the problem.

Editorial Notes: I think learning about medicinal plants will be very important in the long run, as they apparently were in Cuba after their own 'Peak Oil' (see excerpt below). But I also agree with Dr Barson's comments on natural and holistic therapies as not always scientifically proven, and often questionable. Holistic healthcare (as opposed to therapy or medicine) might be considered more broadly as something which informs building codes, food security policy, environmental policy, education, economic policies, etc. indeed most of the aspects of regional planning -- and this approach would seem to have quite a lot to offer an energy scarce world. David Suzuki recently interviewed Dr. Fernando Funes Sr. a researcher at the Pasture and Forage Institute (IIPF) in Havana about Cuban agriculture and health care in the 'Special Period' of oil shortages:
HOW DID THE SPECIAL PERIOD AFFECT MEDICINE? I haven't told you anything about the human health. This movement is connected with health. We encourage the movement in support of the use of medicinal plants or green medicine. We had a great support from the army at that time. The army was the first to start this movement. No one could ever imagine such a thing as the army is always seen as the destroyer or as war makers. Well the Cuban army started this so wonderful movement, which is the use of plants to save human lives. Because we ran out of aspirin in Cuba. It's not only that we didn't have food but also we were out of medicines, so we noticed that wild marjoram was good for well breathing or that some other give us relief from rash in the skin and other were good for some other illnesses. Then the army played an important role, afterwards it was handed to the Ministry of Agriculture. So we made a great production of medicinal plants as in Cuba they were produce only with a preventive approach we also use it with curative purposes. As our concept upon medicinal plants was very different from this modern drugs as they are nowadays, it's like preparing men for his body to be... even though Cubans life expectancy is around 67 years old, even with all these problems we have had and I think that with all this latest news we are about 76 years. This life expectancy thing is something to be taken into account. I also believe that this movement has a lot of followers throughout the country. It's something Cuba can show to the world and share even with more developed countries such as Canada and that how many other countries can modesty learn from Cuba. From things we can do in a more efficient way, more economical and on top of that healthier which is also very important. It's also compatible with the environment without having to use oil or the fossil energy which is being wasted out, and also the subsoil contamination under process, as well as the air and our environment.
-AF

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