Wendy McPhee is facing a difficult decision all too common for those living in regional areas — whether to drive hours away for essential medical care, or to relocate to a bigger city.
The resident of Emerald in Queensland's Central Highlands is very close to kidney failure, stemming from a strep infection more than two decades ago.
"In the next year, it's expected that I will require dialysis — unless I get a live kidney transplant," Ms McPhee said.
But there are no dialysis services in Emerald, meaning she will need to make a six-hour round trip to Rockhampton three times a week.
"For me, I would [instead] probably go and live in Brisbane," Ms McPhee said.
She said setting up a unit at home was not an option because her rural property ran on bore water, which was not of high enough quality to use for dialysis treatment.
Queensland Health said it had opened 38 additional dialysis treatment spaces in regional parts of the state over the past two years, but large geographical gaps for services — such as in places like Emerald — were still being felt.
Demand for treatment was growing nationally, with the number of people requiring kidney replacement therapy more than doubling to 27,700 people between 2000 and 2020.
A 'huge empty spot' on the map
Ms McPhee and her GP husband, Dr Ewen McPhee, have been stalwarts in the Central Highlands for more than three decades.
They are two people the community is desperate not to lose amid a worsening rural GP shortage.
The pair had planned to move after retirement in about five years but that would likely happen sooner.
"He [Ewen] really doesn't want to make this about him, and I don't really want to make it about me either, but we're just an example of what can happen," Ms McPhee said.
State LNP Member for Gregory Lachlan Miller has campaigned unsuccessfully for several years to bring health services to the town.
It has prompted Emerald resident Jane Davis to launch an online fundraiser to establish local dialysis treatment, either at the hospital, which has existing infrastructure, or at the medical centre where the McPhees work.
"If you look at a map of Queensland, and where the dialysis centres are, there's this huge empty spot in the middle of Central Queensland where there's nothing," Ms Davis said.
"We all know we have to travel to go to specialists, but it might be one trip and a hospital trip. This is three times a week, conceivably for the rest of your life."
She said services promised for Longreach two years ago by the state government had not yet been delivered, meaning any publicly funded treatment centres for Emerald could take years to establish.
"Currently the fundraiser is set at $20,000," Ms Davis said.
"In so far as having to set up a dialysis, you're looking at around $10,000 just for a chair. That's without the units,"
She said for a full treatment space, with staff, the cost could be hundreds of thousands of dollars.
Government rolling out 33 services
In the lead-up to the 2020 state government election, the state government promised 33 new dialysis services for the state, worth $27.3 million.
Most have been delivered but not all of them.
A Queensland Health spokesperson said promised services for Longreach, Proserpine and Kowanyama would be opened in the next year.
Dialysis chairs promised for Clermont had been redirected to Bowen, following a "local review and discussion".
The spokesperson said any new services needed to be justified by sufficient and sustainable demand to be clinically safe.
"If new or additional services are required, we will work in partnership with our communities to develop an appropriate business case for consideration."
People travelling for treatment
In Queensland, there are 49 locations set up for chronic in-centre adult dialysis chairs, meaning many within the state still have to travel for treatment — something that is not uncommon across the country.
"Anecdotally, we do know that people have to pass through a number of towns to reach their dialysis unit," Kidney Health Australia clinical director Dr Karen Dwyer said.
"Some of those towns actually do have dialysis unit, but are full."
The exact number of Australians needing to drive long distances for services was unknown but Dr Dwyer said work was underway to try and determine numbers via the Australia and New Zealand Dialysis and Transplant Registry.
"[It's] fundamental for us in terms of further planning," she said.
For Ms McPhee, it was time to think about a new model.
"I just feel like waiting for the public system is going to take too long for people in the community, so maybe we need to think about it differently," she said.
She said a public and private partnership could work to secure local services.
"But if we get to the stage where that's not going to be option either, then we'll just have to raise more money and try and put the whole facility private," Ms McPhee said.
She said if that happened, arrangements would be put in place to make sure no one had to pay for the dialysis services.
