Retreating floodwaters reveal a long road ahead for NSW communities

This article was updated at 3.07 pm on 30 March.

In over 20 years as a GP on the mid-north coast of New South Wales, Dr Iwona Mrowka has experienced flooding, but never anything like what she witnessed this past week.
 
While the Windsor practice that she is a local partner of is on the first floor and was left largely unscathed by the downpour, heavy flooding on the street level has left it inaccessible to patients, forcing a temporary closure as the team navigated its next steps and made a transition to telehealth.  
 
‘The reality was very stressful,’ Dr Mrowka told newsGP.
 
‘A lot of our patients are of age, and they were getting scared and confused. There were lots of issues in relation to follow up appointments; you have to make sure that they have enough scripts, especially people who are taking medications for pain and need regular reviews.
 
‘We were actually very happy with the fact that we had power, so we could do a lot of phone consultations. I did probably about 40 phone consultations yesterday to be able to reach the patients and we were rescheduling appointments as well.’
 
Despite the added stress, Dr Mrowska said other local practices came to the rescue and offered to take on patients that needed to be seen in-person.
 
But with the practice all set to commence its rollout of the coronavirus vaccine on Tuesday, there was another key concern – ensuring the batch of 400 Oxford University/AstraZeneca vaccines, as well as flu and yellow fever shots, weren’t impacted by a possible power failure.
 
‘We did have quite a lot of stress related to our vaccines – the situation was very unpredictable and the conditions were changing,’ Dr Mrowka said.
 
‘We contacted the Public Health Unit and there was no clear direction on what we are going to do about this. We had Dr [Snehal] Patel from Bligh Park [Family Practice] who offered his fridges to keep our vaccines, so this was extremely helpful.
 
‘So we’ve just been trying to help each other, but there was a lot of confusion and no clear directions.
 
‘We have a disaster plan, so we’ve been trying to follow those rules, but you just assess the situation on almost an hourly basis and respond to it the best you can. We’ve been trying to use logic and be as pragmatic as we can and do the best we could under the circumstances.’
 
Dr Ashlea Broomfield, a GP in Woolgoolga also on the NSW mid-north coast, says while GPs are clearly well-placed to help their communities, they must be considered as part of the disaster response. 
 
‘The biggest thing to recognise here is that GPs live and work and are part of communities – we aren’t just treating people from an emergency services perspective or acute hospital perspective,’ she told newsGP.
 
‘We support them in their lives long after the disasters have occurred, and we’re also best placed to provide that level of local intervention. But it can be hard to know exactly what we can do or what is available because we’re not often considered in the disaster response.’


Floodwaters have taken a heavy toll on Windsor. (Image: Supplied)
 
Queensland GP and Chair of RACGP Specific Interests Disaster Management, Dr Glynn Kelly agrees.
 
He told newsGP the response to the floods 12 months on since the bushfires are like déjà vu – and precisely what the RACGP’s submission to the Bushire Royal Commission sought to address in 2020.
 
‘The college put in some very strong recommendations to the commission, which were accepted. But they now need to be actually operationalised,’ Dr Kelly said.
 
‘Of course nobody planned on the floods coming. My point is, we don’t plan on disasters occurring, but we should because we know they will occur [because] they occur on a repetitive basis in Australia.
 
‘The Commonwealth, state governments, local health districts, local councils all need to be prepared.
But there [also] needs to be better involvement of general practice as a system in state, federal and local disaster plans, so that GPs can respond as effectively as possible, and as safely as possible.’
 
By giving general practice a seat at the table, Dr Kelly says GPs and practices will be able to better anticipate disasters, rather than be reactive.
 
‘I will say, when disasters occur, GPs do respond magnificently; they step up and they help out their colleagues. But that’s all ad hoc,’ he said.
 
‘We should be doing a lot of the work beforehand because there’s so much that general practice as a system can do if there’s coordination.
 
‘For example, if “Dr Smith’s” surgery gets flooded, he would have a buddy practice 10 kilometres down the road that will take his patients, or they’ll give him a room where he goes and sees all his patients.
 
‘If there’s an evacuation centre … patients may have medical conditions while they’re in the evacuation centre, patients may not have medications. They need GPs to be able to go there. But who’s going to go?
 
‘At a system level, it would be better if this was coordinated and it isn’t, simply because there’s no pre-planning, preparation and exercising involving GPs in disaster plans, disaster planning, and so on.
 
‘For example, here in Queensland, if they have disaster exercises, they get ambos, police, and hospitals, but they don’t involve general practice.’
 
A member of the RACGP Expert Committee – Practice Technology & Management that covers disaster planning and preparation, Dr Kelly says efforts are being made to address how the college’s submission can start to be operationalised.
 
‘If we don’t, then two years down the track we’ll have bushfires, and nothing would have changed. Five years down the track we’ll have floods, and nothing would have changed,’ he said.
 
‘The same thing goes for pandemics. We need to be better prepared with the GP capacity.’
 
Even though Dr Mrowka says the immediate stress is easing, a forecasted rising tide on Sunday means there is still uncertainty and the extensive clean up that awaits will likely be a long road.
 
‘The fact that the water is going to regress doesn’t necessarily mean that we’re going to be easily accessible because a lot of patients are on the other side of the bridges,’ she said.
 
‘It needs to be cleaned first, for the bridges to be open, for the patients to be able to come to the practice. So there’s this ongoing loss of employment and income, especially for the staff, which is a lot of worry.’

Meanwhile, Dr Mrowka anticipates GPs will have much to contend with in the aftermath.
 
‘We are worried about possibility of infections with mosquitoes, with gastrointestinal infections, and people need to clean [the mess] so there will be probably be lots of injuries in relation to that as well,’ she said.
 
‘I specialise in mental health and believe that this is going to have an impact. People are going to lose their properties, especially when they’re not insured. This is going to be enormous mental pressure on them, stress, low mood and anxiety.
 
‘We just have to help them to get through this crisis.’
 
The Department of Health was contacted for comment.
 
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