Re-birthing regional medical care

Adapting to rapid change during the global pandemic

General Practitioner, GP Obstetrician and GP educator. Dr Teena Downton has her hands well and truly full wearing three very important hats.

Add to that the global COVID-19 pandemic, which has stopped the world in its tracks, and necessitated the medical world to review guidelines and procedures in response to the crisis as it unfolded.

Based in Cowra in regional NSW, the University of Wollongong alumna works in private General Practice and at the Cowra District Hospital, providing antenatal, intrapartum and post-pregnancy care. Teena says that she and her colleagues had to be extremely nimble to adapt to the ever-changing COVID-19 situation.

“It’s been an interesting time where we are getting updates every few days. The guidelines are being updated regularly, and staying abreast of them has been a responsibility as clinicians, we all have had to do.”

Dr Teena Downton standing in a rural field

For maternity care, staff had to re-evaluate the priority of appointments to be conducted either face to face or telehealth, to reduce the chances of pregnant women attending appointments where they could potentially come into contact with the virus. Major adjustments to maternity patient access to Cowra District Hospital also had to be made.

“For a pregnant woman to attend our maternity unit, they would normally have to walk through most of the hospital’s general ward, where most of the other patients are.

“The pandemic has led to changes where we have physically opened up a second entrance to the hospital specifically for maternity patients so they don’t have to walk through the whole hospital to get to their midwife appointments,” Teena explains. “We’ve also had to communicate to them to bring only one support person with them while giving birth and during visits.”

A substantial amount of additional planning had to be undertaken as part of the hospital’s precautionary measures, in the event a pregnant woman presented with the novel Coronavirus.

“Fortunately, in Cowra there haven’t been any cases to date, however we made arrangements to assign one of our labour rooms as the COVID-19 birthing room.

“We have also been negotiating with patients and our Child and Family Health nurses, so patients who are in a position where they could potentially go home one or two days earlier than normal, are being supported to return home sooner, with earlier follow up care in the community.”

While Cowra has been fortunate not to have any COVID-19 cases in the community, other major regional centres have not been so lucky.

“There have been some cases in some of our surrounding centres, including Orange Hospital which is our regional and referral centre.

“There were some discussions about our hospital potentially managing pregnant patients who would normally birth in Orange, whereby they might be redirected to us if bed capacity or social distancing of patients required them to come to us because we could provide a safer environment,” Teena adds. 

Metro versus regional medicine

While the majority of COVID-19 positive cases have been in the metropolitan and larger regional centres, Teena says small district hospitals like Cowra have had to ensure they’ve continued to implement all the recommendations and guidelines.

“I guess the biggest difference is that each hospital has had to have that extra level of thinking; which patients are we in a position to manage and which ones do we need to refer out because we haven’t got the capacity to manage them.

“Because we’ve got limited access to ventilators and staff who can provide round-the-clock care for patients requiring intensive support, I guess we don’t see our role as being at the pointy end of managing care for the really unwell patients. Our role, rather is to stabilise patients, manage the milder cases, and ensure all patients get to the right place they need to be.”

When it comes to managing the usual pre-winter flu shots this year, they have taken a very COVID-safe approach, with social distancing considerations firmly accounted for.

“Our medical practice has moved the flu immunisations off-site to the showground. Instead of lining up in a physical line, patients have been advised to line up in their cars to receive their shots,” Teena shares.

Educating future GPs in COVID times

In addition to her role as a GP and GP Obstetrician, Teena also works as a medical educator for General Practice trainees. Like all educators across the country, she has been forced to quickly transition from face to face delivery, to an online format.

“We’ve had to make sure when registrars are doing telehealth that they’re getting adequate access to their supervisor. Normally they would access them face to face or over the phone, but it’s different when performing consultations over the phone or via platforms such as Zoom.”

Throughout the pandemic many GPs and registrars have experienced a reduction in patient numbers which has challenging flow on effects to their income levels, their learning experience and in some cases, has even meant a delay in their [the registrar’s] ability to fellow with their vocational training college.

“Some trainees are having their training paused due to temporary secondments into other hospital departments. Many hospital-based trainees have been seen as valuable resource to help manage the potential surges and medical workforce needs of the pandemic.

“Trainees have also not been able to complete their training and apply to become Fellows of their Colleges as soon as they would like because exams have been cancelled or postponed and mandatory courses that are traditionally delivered face to face are not running at the moment,” she explains.

Self-care of a medico

On a personal level, Teena has had to ensure she takes extra precautions with her own movements during these heightened health restrictions.

“I’ve become more mindful of my own risk of COVID-19 and how this relates to my members of my family, and the patients I look after. So I’ve been trying to make sure I keep my clinical and non-clinical work quite separate.”

She shares she has been missing the ability to go out for a meal, participate in Park Run and her weekly folk band sessions, where she plays the piano accordion. And she acknowledges the importance of staying connected with friends, family and those more vulnerable in the community, while also supporting small business owners.

“I think it’s just a great reminder to try to be more grateful about what we all still have and try and help out those who have been less fortunate than me.”  

Dr Teena Downton
Bachelor of Medical Science, 2008
Bachelor of Medicine/Bachelor of Surgery, 2012