The flooded general practice governments forgot

When Dr Richard Draper and Courtney Hodges set up their general practice, they had a vision for what they could achieve for their rural NSW community in Forbes.
 
Having grown up in the area, Ms Hodges had a strong sense of the gaps in its healthcare system. Dr Draper had moved more recently but brought with him decades of experience as a rural GP and a deep insight into the challenges of general practice beyond the big cities.
 
‘The model of care that we were hoping to do deliver was really born out of a lot of patients that were landing in Richard’s consultation room,’ Ms Hodges told newsGP.
 
‘There was always this mental health aspect to people’s lives and a real undersupply of services, particularly in the mental health space, and specifically psychology, in our community.
 
‘Patients would have to travel 150 kilometres just for a psychology visit, so that was a big part of our vision … the mental health aspect.’
 
Ms Hodges and Dr Draper set about turning their plan into clinical, concrete reality. They dug deep, bought a building and spent hundreds of thousands of dollars setting it up.
 
Eventually, their concept of a multi-disciplinary practice in the bush was standing before them and the ‘small but mighty’ Forbes Medicine & Mind practice, as described by Ms Hodges, opened its doors in late 2018.
 
That was, of course, a little over 12 months before COVID-19 arrived in Australia, a huge challenge to GPs across the country – but it was extreme weather events that have proved a bigger threat to the Forbes clinic.
 
Two floods hit the town in November last year, with the first a harbinger of worse to come.
 
‘The first flood … really took me by surprise of how close we got to getting water into our building – we were within one brick layer of having water in our floor and that kind of stunned me,’ Dr Draper told newsGP.
 
While that served as a warning about the vulnerability of their practice, they still describe a chaotic sequence of events once the Lachlan River continued to rise to near record levels.
 
A few days after the initial flood, they woke up to the news that large swathes of nearby Eugowra were underwater.
 
‘Somewhere around about half past nine, 10 o’clock on Monday morning, I realised we’re going to be flooded, we need to get everything out of the building,’ Dr Draper recalls.
 
‘We just knew this god-awful amount of water was coming,’ Ms Hodges adds. ‘And I remember part way through that morning session, we made the decision, “we need to start turning people away”.
 
‘It all happened within a matter of hours.
 
‘The CBD was being evacuated and shut down. At one point we were having some confusion about how we were even going to get out of the CBD because they weren’t letting people leave in vehicles.’
 
According to Ms Hodges, the experience of the pandemic held them in good stead at this point.
 
‘One thing that we did have up our sleeve, which really served us, was the pandemic and the fact that we were very good at being able to flick to a telehealth model on a minute’s notice,’ she said.
 
‘Had we not done a couple of years with that model of care, the floods would have looked very differently for us.
 
‘That was a real strength – in hindsight I can see now that we had a lot of those processes in place that enabled Richard to work from the kitchen bench for a couple of weeks.’
 
At first, the reality of what had happened to the clinic in which they had invested so much of themselves did not sink in.
 
‘We caught a fire truck into town and we had to put gum boots on and wade through water and we finally got into our buildings for the first time,’ Ms Hodges said.
 
‘That’s when it really hit home for us.’
 
Friends, neighbours, family and patients rallied around them to help, acts of generosity matched by the wider community. There were the motel owners that allowed them to stash salvaged equipment when the waters rose; a not-for-profit organisation that facilitated a place for them work rent free for six months, and the local hospital allowing them to use an outpatient room for procedures.
 
‘Everyone was fantastic,’ Dr Draper said.
 
‘Oddly enough, it didn’t really hit home to me until we got part way into the renovations.
 
‘It was like, “Oh we did all this for four-and-a-half years ago, and prices have gone up 60–80% based on what we had to pay”.
 
While they have been able to access a business recovery grant, Ms Hodges says it only covers a fraction of their costs – which she estimates exceed $300,000 with lost income and works. For more than a month after the floods, they could not pay themselves a salary.
 
It is unsurprising that Dr Draper and Ms Hodges, who are partners in life as well as in business, have also paid a significant personal toll.
 
‘The pressure for service delivery really started to amp up [when] the water had gone, and a lot of people were returning to life as normal,’ Ms Hodges said.
 
‘Some people really needed us and we didn’t have much left ourselves, and I remember feeling “oh gosh, how are we going to get through this?”’


Despite the challenges, Dr Draper and Ms Hodges have decided to keep the clinic going.

Dr Draper feels the same, recalling the physical exhaustion of the initial recovery phase, and the uncertainty that followed.
 
‘I have to admit that at times, I thought “we could just shut down and go and find other jobs,” he said.
 
‘But as well as looking at the service delivery for the patients, the part that drives me is that the staff we have are fantastic and I feel a great need not to let them down.’
 
Ms Hodges believes that without community support, the practice would probably have closed – a feeling brought into sharp contrast by the sense of being largely overlooked officially.
 
‘There’s already this extreme pressure in rural communities for the clinician to be all the things right, and here we were impacted ourselves, financially impacted, physically impacted, emotionally impacted, with 3000 patients on our books, people that are dealing with trauma from the event … it is a lot to ask,’ she said.
 
‘We have been left with little to no support from the government at the most challenging of times, when we are least equipped to do it, but when our community needs us most.’
 
They compare the government response in their area with the support in the Northern Rivers, where $5 million of joint state and Federal grant funding was announced earlier this year ‘in recognition of the unique challenges that primary care providers in the Lismore community face’.
 
While Ms Hodges is acutely aware of the devastation in that region, she believes many of the challenges are parallel.
 
‘Do I see a distinction between doctors that serve the community, and the need for those communities to be supported by government? No, I think it’s the same issue,’ she said. ‘Particularly when you think we’ve got five full-time permanent GPs in this town.
 
‘We’re a small community, yes, but we’re massively under resourced.’
 
A spokesperson for the Department of Health and Aged Care told newsGP that ‘assistance available to practices in Forbes is consistent with assistance provided to other flood-affected areas of Australia’.
 
‘The Government decided to provide specific additional assistance to Lismore because of the repeated and severe nature of the flooding events there,’ the spokesperson said.
 
It is not a response that is likely to cut much ice with Ms Hodges, who stresses the public spirit behind their work.
 
‘Yes, we’re a private enterprise but we have literally tipped in hundreds of thousands of dollars to a community service,’ she said.
 
‘There’s basically no profit in this for us. That’s a sentiment that’s often lost on our politicians and policymakers.
 
‘The decisions we’re making are definitely not smart ones from a financial viewpoint, but we care about the community.
 
‘We’ve also invested a lot emotionally into doing something that we believe really improves the health outcomes of people.’
 
Dr Draper says the work is one of the lowest paid jobs he has had ‘in decades’, but he has resisted the temptation to pursue much more lucrative opportunities as a locum.
 
‘There’s not really that many spare doctors around,’ he said.
 
‘If [patients] can’t see me, there’s not really anyone else who’s going to step immediately into that.’
 
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