Mining boom creates health hole

The rapid increase of fly-in fly-out workers in rural areas is posing a number of complex challenges for medical staff. Flynn Murphy reports.

The resources bonanza has sparked one of Australia’s largest ever periods of uninterrupted economic growth, but the expansion of this multibillion-dollar industry in rural areas has brought about a huge mobile workforce that is pushing health services to the brink.

“Fly-in fly-out” (FIFO) workers are the big issue and an ongoing federal inquiry into their use and impact on communities will be very important for rural nurses.

FIFO workers are employed in heavy industries such as mining and construction and are concentrated around Queensland’s Bowen Basin and Western Australia’s Pilbara region. They are typically housed in purpose-built camps in or near existing rural communities and rely heavily on existing services and infrastructure. They often work continuous production cycles of 12-hour shifts in blocks of weeks or months at a time.

Many camps lack basic healthcare facilities and, given the sparse population of the average rural town, the influx of workers can cause it to double in size relatively quickly. Estimates peg the current number of FIFO workers in Australia at 150,000 to 200,000, and the number is growing rapidly.

There are more than 150 submissions to the federal inquiry from citizens, government bodies, industry groups, medical professionals and researchers, and they paint a complex picture of life in communities that support large transient workforces. Nursing Review spoke with nurses, doctors, union officials and residents, all of whom had serious concerns.

FIFO workers raise two key issues for health workers: statistical anomalies created by large, non-resident populations are a barrier to adequate health resource allocation, and the workers themselves have unique health needs.

Queensland deputy director-general of health planning and infrastructure John Glaister told NR in a statement that the state government takes non-resident workers into account when planning rural health, by using population projections prepared by the Office of Economic and Statistical Research (OESR).

But their methodology is flawed, said Professor Kerry Carrington from Queensland University of Technology. An expert in sociology and criminology who has researched extensively the issues associated with FIFO workers. Carrington told NR that she commends the OESR for trying to factor them into their estimates, but that rapid fluctuations in non-resident populations make projections unreliable, and continue to lead to widespread gaps in service provision.

“There are no adequate methodologies that have been developed in Australia to accurately record these fluctuations,” said Carrington. “The numbers of non-resident workers planned for are typically lower, in some cases substantially lower, than the actual numbers.”

In one example, in the coalmining town of Moranbah, in the Bowen Basin between Brisbane and Cairns, local doctor Johann Scholtz said health services are facing unsustainable pressure.

“The fly-in fly-out workforce causes the population to more than double. How can you argue that doesn’t have an effect on services?” he said. “Availability of appointments for the local population gets more and more difficult, wait times increase … [Meanwhile] the Queensland Department of Health is missing in action.”

Scholtz, who has lived in the town for 15 years, co-owns the Moranbah Medical Centre and works part-time at Moranbah Hospital. He has made a submission to the federal inquiry.

He estimated about a third of his patients were non-residents and said that, aside from the change in volume, fly-in fly-out workers posed a number of complex health challenges for his staff.

“It’s a very time-consuming type of medicine because you don’t know the patient – their history is not available to you, and there are often workplace injuries which involve paperwork that has to be done.”

He said that the mobility of the workforce, combined with the close proximity of the workers, increased the likelihood of the spread of disease.

“Any flu that is going around in Melbourne, for argument’s sake, will find its way to Moranbah. And in these camps people quite often live in close confines, so if one has a flu or a bug, it’s very likely to spread to quite a number of others, and that too puts pressure on the local workforce.”

“Companies think that they can put a nurse or a paramedic or an occupational first-aider into a mining camp where there are 3000 or 4000 people living, and they think that will alleviate the pressure on medical services. They’re living in cuckoo land.”

Scholtz echoed the thoughts of a number of people interviewed by NR, blaming the gap in services on a government they say has systematically granted mining leases without adequate plans to support local infrastructure. One man who shared this view was Queensland Nurses Union assistant secretary Des Elder.

Elder said it was important to remember the other impacts that the resources mining boom had on cost of living and rent for rural nurses. Accommodation shortages have driven rent up to heights that would make many city-dwellers blush: up to $3500 a week in Moranbah, and up to $600 a week in Mackay, where many miners live.

“It’s a real issue in terms of recruitment of nurses to develop a workforce to meet the requirements of the regions. There has to be a lot more workforce planning to deal with this sort of influx, without just hoping the market will sort it all out.”

The Queensland Nurses Union estimates that Mackay will double its nursing workforce requirements by 2014-16, needing 158 new beds and an additional 400 FTE nursing positions over the next two years. There is no word on where these nurses will come from. The question of how to solve these issues is equally complex.

For former Queensland Labor MP Jim Pearce, the answer lies in mining companies themselves. When contacted by NR, Pearce, who authored the Construction, Forestry, Mining and Energy Union’s (CFMEU) submission to the inquiry, attacked what he called the “arrogance” of mining companies and their failure to address community needs.

Pearce said when it came to rural healthcare in FIFO-dense areas, it was the companies that needed to foot the bill.

“They’ve got to realise that it’s because of their massive expansion of the industry at such a rapid pace that we have this new culture of fly-in fly-out, so it’s their employment policies and their push to get as much coal out of the ground as quickly as they can, which is what is putting pressure on the communities. They’re so coal hungry these guys would dig up their own backyard if they thought there was coal there. It’s their responsibility.”

Pearce proposed that mining companies pay a levy of $20 a week per FIFO employee into a treasury-administered fund which could be used to provide essential services to the communities that shoulder the burden of the boom. He estimated his proposal could raise about $20 million a year, and that if the workforce grew at projected rates the sum could soon amount to $40 million.

He suggested local community groups could decide which projects they would like funded, and make applications to a management panel made up of community, local government, state government, mining company representatives and unions.

The imposition of a compulsory levy on mining companies to contribute to rural health services has been backed by both the QNU and the Australian Medical Association. “I don’t have a medical background,” said Pearce, “but I’ve been in this part of Queensland for 30 years, I’ve worked in the mining industry, I’ve lived in these towns, and they are in the worst condition they have been since [the mining companies] came to central Queensland. There are fights and brawls starting where instead of one or two blokes there are a lot of people involved. There’s a lot of alcohol abuse, there’s a lot of talk around Mackay and Rockhampton at the moment about drugs.”

It’s a concern supported by the Carrington’s findings. She told Nursing Review that in many of the communities she has studied, alcohol-fuelled violence and social disorder have increased markedly. Regional communities alongside large mine and construction camps could be twice as violent as the state average, with one West Australian mining community having a rate of violence 2.3 times the state average, and one Queensland mining community having a rate of violence that had grown from 534 per 100,000 in 2001, to 2315 per 100,000 in 2003.

Pearce said that big changes in the demography of rural towns, particularly the influx of “thousands of single men”, would inevitably lead to these sorts of social issues, and alienate local residents.

“You can’t blame every fly-in fly-out worker and say that they’re no good, because most of them are ordinary working people with families trying to look after themselves,” said Pearce. “But you only need a handful when you’ve got a couple of thousand workers in the town.”

Scholtz added: “In the old days it used to be that you could earn much more money if you went out bush. If money was an attraction, then that attraction is not there anymore. You have to pay $3000 for rent. Every new doctor or nurse we get in – they’re not prepared to pay that money.”

“At some point the existing service providers are going to say ‘this is too hard’, pack their bags, and move to the coast. And then these communities will be without services.”

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