The Healthcare System in the Cocos (Keeling) Islands: Health Centres, Medicare, Emergencies and Evacuation

The Cocos (Keeling) Islands have no health system of their own. The Indian Ocean Territories Health Service (IOTHS) is the Australian health service responsible for the two Indian Ocean territories, Christmas Island and the Cocos Islands. The Shire of Cocos (Keeling) Islands specifies that this service provides hospital, outpatient, community and dental care, and that it includes, for the Cocos Islands, the Cocos (Keeling) Islands Health Service, which runs health centres on West Island and on Home Island. The Department of Infrastructure describes these facilities as small clinics: hospital stays on the island are limited to one night while awaiting evacuation to Perth.

The two centres are located on Jalan Masjid on Home Island and on Sydney Highway on West Island. They offer general practice, nursing care, community health programmes, an emergency service and laboratory tests. Specialists and allied health professionals travel in intermittently: hospital doctor, paediatrician and child health nurse, ophthalmologist or optometrist, physiotherapist, speech therapist, podiatrist, pharmacist, dentist, psychologist. This offer varies from visit to visit, and the visit schedule should be requested from the health service before planning a non-urgent procedure.

CLEISS lists among the people covered by the Australian scheme the citizens and permanent residents of Norfolk, Cocos, Christmas and Lord Howe islands. The Australian Department of Health sets out the general rule for Medicare: you must ordinarily live in Australia, be in Australia at the time of care and be a citizen, permanent resident, New Zealander, holder of a resident return visa, applicant for permanent residence (under conditions) or holder of a temporary visa covered by a ministerial order. Other visitors and temporary residents are not eligible for Medicare and must take out private insurance.

Australia has concluded reciprocal agreements with eleven governments: Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, Ireland, Slovenia, Sweden and the United Kingdom. France is not among them, and France Diplomatie indicates that no bilateral agreement in the field of social cover links France and Australia: the carte Vitale opens no right on site. A French national who settles on the island in practice obtains Medicare if they become a permanent resident or if their visa appears in a ministerial order. Enrolment is done with Services Australia. See the page Australian healthcare system for the detail of Medicare nationwide.

First contact is the health centre on your island. The Shire indicates that the centres open on weekdays during the day, that consultations with the doctor or nurse are by appointment, and that the doctor is present only on certain days of the week on each island, with nurse consultations between visits. A resident living on West Island and a resident of Home Island therefore do not have the same calendar, and the ferry crossing of the lagoon, about 8 km, is a factor for an appointment on the other island.

The Department of Infrastructure indicates that consultations covered by the Medicare Benefits Schedule are free of charge for Australian citizens and permanent residents. For a patient without a Medicare card, the health service applies other billing arrangements: they should be requested before the consultation, and the invoices kept for one’s insurance company or, where applicable, for reimbursement on return to France (see healthcare reimbursement).

France Diplomatie indicates that the single emergency number for the whole of Australia is 000. On the Cocos Islands, the Shire describes an emergency service operating 24 hours a day, 7 days a week in both health centres. After opening hours, an on-call nurse can be reached by telephone on each island, and a recorded message gives their name and how to reach them. If there is no telephone answer, the Shire specifies that you can call on any marine radio, channel 24, and that a radio is available to the public at the entrance of each centre, with its instructions. A notice on the door of each centre explains how to reach the on-call nurse.

Cases beyond local means are referred to Perth, by medical evacuation. No official source read publishes the cost of an evacuation, or says who pays for it for a visitor: France Diplomatie reminds us that these costs can in no case be borne by the embassy, and that without cover access to care may be refused, even in a life-threatening emergency. An assistance contract that includes evacuation and medical repatriation is the intended answer to this risk; see repatriation and assistance.

France Diplomatie describes Australian hospital infrastructure as excellent and refers to an Australian government portal that lists hospitals by city. For a resident of the Cocos Islands, the reference hospital is on the mainland, in Perth. Free access to a public facility depends on Medicare eligibility; a patient who is not eligible relies on their private insurance, as the Australian Department of Health reminds us. France Diplomatie adds that a seriously ill person who wishes to settle in Australia may be refused entry if they lack sufficient resources to cover their care: a plan to settle should therefore be prepared with your doctor and your insurer.

The insurance contract must cover not only care on the island but also the journey to Perth and the stay there, as well as the return. See also living in the Cocos (Keeling) Islands for the territory’s logistics.

The Shire lists a pharmacist among the professionals who travel to the island: the sources read describe no dispensing pharmacy on either island. You should carry a stock of your usual medicines for the length of the stay, with the prescription, and enquire with the health centre before departure about supply options. The subsidised medicines scheme (Pharmaceutical Benefits Scheme) is for Medicare holders; a patient without a card pays the full price of the medicine (see the page Australian healthcare system).

Dental care is provided by a dentist and a dental therapist who travel to the island, and optical care or physiotherapy are offered during specialists’ visits. Care outside these visits involves a trip to the mainland, to be included in the insurance budget.

France Diplomatie reminds travellers that the vaccines recommended in France are also essential during a stay abroad: adults and children update their vaccination schedule, in particular against diphtheria, tetanus, polio, whooping cough and measles. Other vaccines may be useful depending on the conditions and length of stay, notably against chikungunya and dengue in the event of an active epidemic or a prolonged stay, and against Japanese encephalitis; yellow fever is compulsory for travellers from endemic areas.

The same page notes that the long flights between Europe and Australia, of about 24 hours in total, can promote thrombosis in people sensitive to immobility. It presents no health risk specific to the Cocos Islands: a doctor or an international vaccination centre specifies the useful vaccines before departure. On climate, the Shire describes subtropical conditions with high temperatures all year round; France Diplomatie recommends, for Australia, avoiding the hottest hours and protecting yourself from the sun.