Ochre Health Medical Centre
Ochre Health Medical Centre in Cohuna is a GP practice that hosts MCCC registrars and partners with Cohuna District Hospital to keep general and procedural practice alive and well in rural Victoria. This story is about the importance of procedural general practice to primary health care in rural communities and the sustainability of the GP procedural workforce.
THE TOWN AND SURROUNDS
Cohuna is 68 kilometers east of Echuca, 120 kilometers north of Bendigo and 247 kilometers from Melbourne. It is a small northern Victorian country farming community in the Gannawarra Shire. While the town has a population of only about 2000 people, it sits within a larger catchment of around 10,000 in a Shire that covers about 3,700 square kilometres. It is a long way from a large regional centre and a very long drive for patients if primary health-care and hospital services are not available locally.
But Cohuna and the semi-isolated communities that surround it, has a thriving GP practice with skilled GP procedural doctors, a well-equipped 16-bed acute care district hospital and a 16-bed community nursing home.
Cohuna hospital has a long and interesting history. For many years it was a private facility owned by local GP, Dr Stewart. In 1952 it was sold to the Victorian Government and became a public hospital. After more than 60 years of continuous service to the communities of Cohuna and surrounding towns, the Cohuna District Hospital remains a ‘GP hospital’ with six visiting medical officer GPs from Ochre Health who are credentialed to provide urgent care on-call and procedural services to the hospital on a rostered basis.
Today under the leadership of Dr Ken Cheng, the hospital offers, interalia, acute medical and surgical services, obstetrics, a 24/7 Urgent Care Centre, a dialysis unit that operates three days a week and a district nursing service.
Since the 1940s GP services at Cohuna Medical Clinic were provided first by Dr Stewart, then Dr Graham and, for 32 years, the clinic was owned and operated by Dr Peter Barker. In 2015 Peter sold the Clinic to Ochre Health, a group of GP practices established in 2002 by Drs. Ross Lamplugh and Hamish Meldrum. Their philosophy, in keeping with that of Cohuna Medical Clinic, is to provide first-class health care to diverse rural communities in a caring environment.
There are about 5000 patients registered at the practice that provides a range of procedural and non-procedural services including trauma medicine, pain management and palliative care. It has been a registrar training ground since the 1980s. A pathology laboratory visits daily to take bloods. Equipment includes ECG monitor, diathermy unit, ultra-sound and full resuscitation equipment.
DR PETER BARKER MBBS, FRACGP, FACRRM
Dr Barker is a passionate and dedicated procedural doctor with skills in anaesthetics, obstetrics, emergency medicine, dermatology, paediatrics and GP education. He has been trained in radiology and does heart films and ultrasound.
Peter’s early training was at Box Hill Hospital, after which he spent time in Cohuna, Bairnsdale and the UK. He joined Cohuna Medical Clinic in 1983 as a trainee on the Family Medicine Program; a forerunner of the GP registrar program. Always interested in working in a rural environment, he was advised by colleagues to expand the range of skills he would need for country practice by working overseas. He subsequently spent two years in the UK doing obstetrics and anaesthetics after which he returned to Cohuna. On his return to Australia he recalls being told that there’s a practice that we can’t get anyone to work in. They are all too scared to go there. And that was Cohuna … [It was] because you had to be able to do anaesthetics and obstetrics.
With over 34 years service, Peter continues to practice with Ochre Health Cohuna and supervises MCCC registrars on a regular basis.
DR MEGAN BELOT MBBS, FACRRM, FRACGP, DA
Dr Belot grew up in Melbourne and completed her MBBS at Monash University and her internship at Box Hill hospital. She did a number of rural rotations prior to doing two years residency in Darwin and a further two years working as a locum. Megan then began her GP training in Echuca and Cohuna, also completing a Diploma of Anaesthetics at Bendigo hospital. She also performed anaesthetic procedures at Broken Hill Hospital and spent a year working with the Flying Doctors Service (RFDS) where she was involved in clinics and retrievals.
Dr Belot joined Ochre Health in 2016 as a registrar in her last six months of GP training. She combines general practice with anaesthetics and works two days a week in Cohuna and two and a half days in Echuca.
DR ALI SHEAAR MD, FRACGP
Dr Sheaar completed his medical education in Iran in 1995 and has worked with Dr Barker since 2010. The system of training in Iran is different from that in Australia as the hospitals are under university control. Ali’s seven years of training included an internship term after which he graduated as a general practitioner. After practising for 15 years in both urban and rural areas in Iran, Dr Sheaar came to Australia in 2009.
In 2014 he attained his Fellowship of the RACGP. Ali’s wife, a dentist, has also fulfilled exacting Australian requirements in dentistry and now practises in Kerang. Although proficient in English, coming to Australia presented its challenges in terms of understanding the Aussie accent and slang, but Dr Sheaar and his family found great community and peer support in Cohuna and enjoy life in the local community.
DR MINA YOUNAN MBBS, FRACGP
Dr Younan came from Egypt to Australia in 2004 after completing his Bachelor of Medicine and internship in Cairo. Mina worked in Mackay in Queensland in 2008 as an intern where he practiced anaesthetics and emergency medicine and worked as an HMO there for several years. Three children later and various stints as an after-hours GP and working as a hospital and emergency locum, he moved to Victoria in 2014. Wishing to continue procedural practice Dr Younan recalled:
“I said, find me a place with anaesthetics, emergency and obstetrics and I’ll work. They said – ‘a small town called Cohuna’. I had no idea where it was. They said, ‘have a look at the place’. It was August 2014, I came and saw Peter [Barker] and he was very welcoming … so we moved here in 2015. It has been a very positive experience, unexpected but positive.” said Dr Younan.
Since moving to Victoria, Dr Younan has attained his FRACGP and is undertaking an ACRRM Fellowship. He gained a Diploma in Obstetrics in Bendigo and is credentialed for Caesars and normal deliveries.
Over time many small rural hospitals have closed or reduced their procedural services because the costs associated with maintaining up-to-date operating theatres are onerous or because GPs have retired or ceased practising procedural medicine. The cost is often counted in unnecessary hardship and adverse health outcomes for patients as well as placing greater stresses on larger regional and metropolitan hospitals as patients are compelled to travel long distances to access treatment.
The doctors at Ochre Health however have striven to ensure continuation of services to their small hospital. Since the 1940s Cohuna’s GPs have delivered babies and performed a wide range of surgical and anaesthetic procedures..
Gastroscopies, dilation and curettes, hysteroscopies, skin flaps, knee and hip replacements are part and parcel of the workload. Each day begins with ward rounds and meetings where the doctors focus on the needs and treatment of each individual patient. It’s been a tradition they’ve kept. They all know what goes on and how each other thinks. They are also happy to consider new thoughts and ideas.
Visiting specialists also form part of the mix and include surgeons who mainly do laparoscopic surgery and varicose veins. Similarly, obstetrics are a particularly important service to the community. As the catchment expanded, partly due to the closure of obstetric services in Kerang, Ochre Health GP obstetricians deliver up to 80 babies a year. It is clearly an exciting and stimulating training ground for GP registrars and those undertaking extended and advanced skills in procedural medicine.
In addition, the nature of the farming industries mean that residents want and need to be treated locally in order to maintain their businesses.
“People are tied to the area … if someone gets sick and has to go to Bendigo the family is really badly disadvantaged. Who will milk the cows? They are going to be lonely. We try to treat them in the local area – and, being treated locally, they seem to get better faster [than if treated elsewhere].” said Dr Peter Barker
As might be expected, The Health Department routinely checks the quality and safety practises of doctors and hospitals under its remit. Cohuna hospital and doctors are no exception and continue to excel.
“We stand up to be counted and [when examined] they found that everything we do is safe.” said Dr Barker
Ochre Health continues the time honoured tradition of “cradle to grave” care and seeks to attract GPs to the region that have the right mix of general and procedural skills to meet the diverse needs of the community.
LOCAL GP ACCESS
The importance of patient access to GP proceduralists in local communities from a cost benefit and community health perspective cannot be underestimated.
Many towns like Cohuna rely on GP proceduralists to provide on-call emergency care, not only for local residents but also for tourists and passing travellers. Providing appropriate, safe professional emergency and other procedural care in a timely manner minimises patient risk and reduces costs associated with delayed access to treatment.