Opinion

One year on: After the Townsville floods


Michael Clements


13/01/2020 1:48:09 PM

Dr Michael Clements reflects on the GP’s role in responding to a major natural disaster.

Flood waters
‘As a GP living and working in Idalia, one of the epicentres of the flood zone, my suburb, my patients and my community were hit hard. My medical practice and home flooded,’ Dr Clements wrote.

With Australia’s bushfire disaster still active, GPs continue to respond with bravery, distinction and a selflessness that comes from wanting to help their community, their people.
 
In the midst of all the activity and reactiveness it is important to start preparing for the recovery.
 
Almost 12 months ago, Townsville and North Queensland experienced a one-in-a-1000-year weather event. More than 3300 homes were damaged, with 1255 made uninhabitable, all within the space of a few suburbs.
 
Thousands of residents were displaced – and some still are 12 months on. Due to the remarkable work of emergency services, the disaster centre, the ADF and the residents themselves, only a small number of lives were lost and residents were able to commence the clean-up and recovery within days.
 
As a GP living and working in Idalia, one of the epicentres of the flood zone, my suburb, my patients and my community were hit hard. My medical practice and home flooded, my family was marooned for days and our suburb became a ghost town.
 
As a parent, my immediate priorities were my family’s safety and welfare. As practice owner, my priority was the safety (and salaries) of my staff. And as a GP, my priority was to help my patients and my community recover.
 
I will take a flood over a firefront any day, so while I can’t comment on the terror, fear and despair still facing so many of our colleagues and residents of the bushfire disaster areas down south, I can give some insight as to what is still to come for them.
 
In the aftermath
Long after the politicians, news choppers, the ADF and the council workers return home at the end of this disaster, the residents and their GPs will remain to start putting their lives back together.
 
Politicians and health administrators will get excited about setting up a new telephone service that people can call to ‘chat’ if they are overwhelmed, opportunistic ‘bushfire group therapy’ companies will form, and websites will pop up using government funding to go in and rescue communities from themselves.
 
But we know it is the GPs who will be shouldering the largest burden of mental health care services in the days, months and years after this bushfire season.
 
That is what has happened in Townsville.

Michael-Clements-Article.jpg
Dr Michael Clements’ neighbours were evacuated after having to seek refuge from encroaching floodwaters.

Interestingly, even 12 months on, local psychologists in Townsville only reported a small increase in demand for services, and often not related specifically to flood.
 
Psychiatry services are overstretched, but they were before the event and we have not seen many more acute psychosis/severe mental health disease requiring intervention.
 
Telephone help lines and group therapy sessions were poorly subscribed.
 
I believe this is due to the fact that, in the immediate aftermath, communities just ‘get on with it’.
 
My patients, some of whom may have lost everything, would universally say, ‘there is someone worse off.’
 
Almost every single patient of mine discussed, through tears, their flood stories. Of being rescued in the dark, in the rain from their roofs, or wading through waist-high water for help. But then they focused on the task at hand and got on with the job.
 
People were too busy rebuilding, arguing with insurers, negotiating with builders, keeping their kids distracted, to take time out to go and see a psychologist, or see a self-help group, or call a 24-hour line to tell a stranger they felt upset.
 
My role very quickly changed from being a GP to a ‘flood counsellor with a little bit of general practice’ in the weeks following the floods.
 
As this was a new role for me, I enrolled in the online mental health skills training package offered by RACGP Rural that qualifies me to undertake Focused Psychological Skills (FPS) therapy sessions.
 
I found this a wonderful introduction to psychological therapies and principles, which I will admit to having previously avoided. Since being qualified I have been able to do a small number of FPS sessions and, more importantly, include FPS principles and techniques into my everyday consultations.
 
If I was king for a day I would have the Federal Government invest significant funds into general practice services in affected towns, increase the number of mental health care consultations under mental health care plans, and listen to GPs as to what the community needs, rather than health administrators.   
 
I am sure some patients will benefit from the pop-up telephone lines that the PHNs will no doubt open up, or from the group therapy sessions that they will soon release. But based on my experience, the bulk of mental health care for these communities will occur in the GP consult rooms.
 
They will attend ‘just for a script’ or ‘to check out this mole’, but after a small bit of probing they will tell their GP of their despair, their hopelessness, their frustration at the bank, the insurer, their builder, their family.
 
They will refuse a psychologist referral because they are too busy and they will not want a psychiatrist because they will feel that everyone else is the same and they are not crazy.
 
Patients will rely on their GP as their sounding board, their confidant. They will ask, ‘Do you think I am doing okay?’
 
Some will want medications, most will not. Most just need the care, attention, concern and time from their GP to listen.
 
We are 12 months on from the flood now, but people are still suffering. Many have returned to their homes, but many have not been able to. Many of my patients are still rebuilding or arguing with insurers or banks or builders, still experiencing sleepless nights and flood-related stress, still suffering financial stress from the event, which will likely persist for years.
 
My street still looks like a scene from The Walking Dead, with houses seemingly abandoned, lawns unkempt and a scattering of shipping containers in front yards.
 
My family and my community will have forever changed, and while I can’t pretend to know how the families and GPs down south are feeling right now, I do know that the hard work for GPs in those communities is only beginning.

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A.Prof Christopher David Hogan   14/01/2020 3:27:47 PM

Dr Clements' comments are fluent, considered & insightful. They match the experience of the many of us who have dealt with disasters.
In times of trouble, people seek the familiar & those who have earned their trust. It is better to expand the existing system than bring in strangers.
It is one time when the good GPs are not invisible