COVID-19 has been an issue which has touched almost all aspects of our lives for nearly two years but, away from the pandemic, the state's rural health system has been dragged to a crisis point.
Borders are set to open next week, which Premier Steven Marshall and SA Health believe will lead to a rise in the number of COVID cases within South Australia.
Even before an expected increase in hospital care once borders open, South Australian towns and hospitals have been reaching a tipping point, leaving staff and communities at risk.
The Karoonda and Districts Soldiers' Memorial Hospital Emergency Department was temporarily closed from Friday, October 22, from 5pm due to unexpected staff shortages.
At Wudinna, sole GP Dr Scott Lewis has resigned after almost 14 years at Wudinna Medical Practice, citing a culmination of issues surrounding rural healthcare and unresolved maintenance issues in his home owned by the hospital.
Health Minister Stephen Wade told Australian Community Media, publisher of this newspaper, that the state government was committed to regional health and would spend $20 million to develop the rural health workforce to ensure high-quality health care is delivered in regional South Australia.
"We recently announced the recruitment of up to 1920 additional frontline health staff across the state, as part of our strong COVID-Ready plan, and we expect that significant numbers of health staff will be added to our regional workforce as part of this," he said.
"Our focus is on providing the best possible care for South Australians, closer to home, and making sure our hospitals are best placed to care for those who are most affected by COVID-19 - projected to be less than five percent of cases.
"South Australians can have every confidence that when our borders reopen, our health system is in the best position possible for the community to access world-class health care."
But a federal Senate inquiry has heard the rollout of COVID-19 vaccines has limited the number of medical appointments available to patients in regional areas due to GP shortages.
A committee examining GP services in rural Australia was told the COVID vaccine program had significantly cut an already low number of services due to the need to prioritise the rollout.
Australian Medical Association's Council of Rural Doctors associate Professor Peter Macguire said patients in remote areas were waiting up to three weeks to see their GP in some instances.
"There is only so much time that GPs have and we are certainly concerned with what's coming," he said.
"We are already under-doctored as it is."
During a member forum held by the Rural Doctors Association of South Australia (RDASA) in August, significant concerns were raised by rural doctors relating to medical workforce shortages across rural parts of the state.
Some communities and councils have been forced to support their local medical practice or hospital, or risk residents going without care.
In the Eyre Peninsula town of Kimba, the Kimba District Council has applied for a grant through the Rural Health Workforce Strategy Steering Committee to provide financial incentive to draw GPs to the region while contributing $200,000 for the upgrade of the council-owned medical clinic.
The town has had long-term issues in trying to secure a permanent GP.
Another Eyre Peninsula town, Streaky Bay, has had an issue in recent years maintaining a permanent doctor and raising its stocks to two permanent doctors, but has been supported by the council and local community.
The resignation of Dr Lewis means there will be no permanent GP between Ceduna and Port Augusta come the start of 2022.
Meanwhile, in July, the three current associate doctors of the Kangaroo Island Medical Clinic took the extraordinary step of publishing a half page letter in The Islander newspaper calling for action to address the rural health crisis.
RDASA president and Murray Bridge GP Dr Peter Rischbieth said in July that many practices were "crying out for more GPs to support their primary care clinics and to provide services at their local hospitals".
The Australian Medical Association in South Australia (AMA(SA)) recently released its '2021 Public Hospital Report Card', which it said provided evidence of the crisis that exists within the state's health system.
AMA(SA) president Dr Michelle Atchison said the annual report card showed that even within an overwhelmed national hospital system, South Australia continued to demonstrate major shortfalls in meeting patients' needs.
"Along with our peers across the country, South Australian medicos are holding our collective breath as we await the true impacts of the Delta variant and long COVID on our hospitals, our patients, and our economy," she said.
"The numbers demonstrate a system in crisis - a system in which patients who should be able to expect to be cared for quickly and safely does not and apparently cannot meet those expectations. Now we are facing the additional burden that will come when the state's borders open to COVID cases on 23 November.
"If South Australia's hospitals can't cope now, what's going to happen when the impacts of COVID cases hit in 2022?"
In an interview with ABC Radio Adelaide earlier this month, Mr Wade said he would follow up with issues highlighted by Dr Lewis.
"In terms of the ongoing challenges for the rural doctor workforce, certainly Scott has been advocating for dealing with the challenge for years. It is voices like Scott that led to the state government investing $20 million on the Rural Workforce Development Plan which is having a significant impact in building pathways for rural doctors," he said.
It is not just patients struggling to find a doctor in their town, there is also the issue of staff being put at risk.
Port Lincoln Hospital staff have issued more than 90 Code Black calls - when staff believe there is a safety threat against them, a patient or another person - since 2016.
The Australian Nursing and Midwifery Federation's South Australian branch reported that recent incidents included a man who was allegedly under the influence of drugs and alcohol smashing the sliding doors of the emergency department, and a nurse being allegedly punched in the stomach by a male patient.
These followed other incidents reported last month, including on October 13 when a patient allegedly jumped from his ward bed and attacked a nurse, trying to bite her; and two days later a man was restrained by police after attacking a doctor in the emergency department.
The federation's branch chief executive officer, Adjunct Professor Elizabeth Dabars, said the hospital needed to do more the ensure the security of staff, including having restraint-trained security guards on site.
She said members at the hospital had told the federation that they were scared to come to work.
Ms Dabars said in June this year the Whyalla and Port Augusta hospitals had committed to having security guards on site 24/7 after 22 assaults against nurses in a month period, which led to a de-escalation in violence.
An Eyre and Far North Local Health Network spokesperson said policies and procedures would continue to be reviewed to improve staff safety.
Shadow Minister for Health Chris Picton, the Rural Doctors Workforce Agency and the Australian Nursing and Midwifery Federation's South Australian branch were contacted for comment.