From dialysis to cancer care, rural South Australians are fighting red tape and distance in the battle for health equity
When you’re dealt a card in this journey we call life, and you flip over “Kidney Disease”, dialysis isn’t optional, it’s survival. Yet in South Australia, survival depends not just on the strength of your body, but on whether you happen to live a few kilometres on the “wrong” side of a bureaucratic line, proof that health equity still isn’t a given for rural people.
For almost four years, Melrose local Bob Moulton, with the support of his wife Jan, has been making the same punishing 140-kilometre round trip along a windy country road, three times a week to Port Augusta. That’s two hours in the car and five hours hooked up to a dialysis machine – a seven-hour day, three days a week, just to stay alive. Let that sink in for a moment.
And in all these years, not a cent of support has been provided through the Patient Assistance Travel Scheme (PATS) for this life-saving three-times-a-week run to Port Augusta. No fuel subsidy. No accommodation. Not even the taxi vouchers city patients get as a matter of course. Nothing.
Bob’s daughter, Eliza Cottle, and the Moulton family have spent years advocating for change. They’ve met with politicians, written letters, and shared their story. One of the simplest fixes they’ve pushed for is PATS eligibility to be based on cumulative kilometres travelled – the total distance covered for ongoing treatment – rather than a one-way threshold that punishes rural families. And still, nothing.
Eliza says her dad isn’t asking for much – just fairness.
“My Dad is not asking for special treatment. He is asking to live out his days with dignity, close to the home and the people he loves. He deserves, as all people do, to be supported to stay in his community — not punished for living rurally with huge travel requirements, out-of-pocket expenses, and exhausted support services.”
A battle no one should have to fight
For Sonja, a sole parent from Halbury, living a few kilometres too close cost her the help she needed. She was recently diagnosed with breast cancer, and on top of the shock and fear of what lay ahead, she had to face the absurdity of PATS eligibility.
Her appointments and surgery are based at Modbury Hospital, but chemotherapy must be done at Lyell McEwin. The problem? Neither hospital is far enough away to qualify for assistance. Sonja lives 97 kilometres from Modbury and 92 from Lyell McEwin – just shy of the 100-kilometre cut-off.
After asking for a review, PATS agreed to waive the three kilometres and cover Modbury, but refused to budge on Lyell McEwin. To add insult to injury, if she ever needs accommodation during her treatment, she’ll have to apply for “special permission”.
If PATS worked on cumulative kilometres, people like Sonja and Bob wouldn’t be penalised for where they live – and this flawed system wouldn’t make people fight red tape while they’re fighting for their lives.
PATS – The worst in the nation
Across Australia, SA’s PATS scheme comes in dead last. The numbers don’t lie.
- Accommodation: $44 a night (compared to WA’s $110).
- Fuel: 32.8c/km (better than Victoria, still well below WA and NSW’s 40c/km and not much comfort when fuel up north can hit $2 a litre.).
- Extra insult: if you’re not a pensioner, you must pay your first night of accommodation yourself.
When “good news” misses the mark
Last week, the government proudly rolled out two big announcements – a holiday dialysis truck in Robe, offering six spots a day so patients can enjoy the beach, and more dialysis chairs in Adelaide’s northern suburbs, with a shiny new 30-chair renal unit at Playford.
Sounds great, doesn’t it? Unless you look a little closer.
The Robe dialysis truck is a wonderful concept – it’s offered in other states and should be here in SA too – but for families like the Moultons, it’s simply out of reach. The daily cost of travelling hundreds of kilometres for essential treatment already stretches most regional households to the limit, leaving holiday dialysis as something few can afford to access.
And the new Playford chairs? Terrific if you live in the northern suburbs. Completely meaningless if you’re in Melrose, Jamestown, or Orroroo. If only we could strap a Playford chair to a trailer and drag it 200 kilometres up the highway.
Save your pity, show us equity
Families like Bob’s and Sonja’s don’t want pity. They want health equity. They want health policies that recognise rural people as equal citizens.
When the government celebrates six holiday dialysis spots in Robe while pensioners in Melrose struggle to afford the fuel to get to Port Augusta – and sole parents like Sonja in Halbury face a postcode lottery for cancer treatment – that’s not equity. That’s a slap in the face.
The fix is simple
- Bring SA’s PATS scheme into line with WA and NSW.
- Base eligibility on cumulative kilometers.
- Fund more rural dialysis chairs so people can get treatment closer to home.
- Provide transport options that don’t rely on exhausted families and limited volunteer drivers.
The fight for fairness
This issue is just the tip of the iceberg when it comes to health equity for rural South Australians. The system’s full of gaps and built around postcodes instead of people. Real reform needs bipartisan support, and thankfully, there’s one woman who’s not backing down.
Alex Thomas knows the fight for fairness won’t be a straight road. Her determination comes from watching her dad, Chris Thomas, forced to choose between leaving his country home for treatment or staying put to die on his own terms. No one should ever have to make that choice.
Now Alex is pushing through the same bureaucratic mess that failed him, demanding a system that values people over policy – because while governments keep holding meetings and patting themselves on the back, country South Australians are still driving hundreds of kilometres for basic care, or giving up altogether.
The message is simple… fairness and health equity shouldn’t be a postcode privilege.
To learn more about health equity and access to rural healthcare in South Australia, visit SA Health’s PATS page or the Health Consumers Alliance of SA
