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.