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Helping infants through trauma

Cate Swannell
Med J Aust
Published online: 5 June 2020

WHEN the MJA catches up with Dr Georgie Swift she is attempting to get three of her four children ready for a day of home-schooling, as well as organising her work in the new world of COVID-19 isolation.

As a psychiatrist for children in care, including infants, COVID-19 has made Dr Swift’s work for the Child and Mental Health Service, part of the South Australia’s Women’s and Children’s Health Network, more complicated, but no less satisfying.

She works partly in child protection but is also with a team called the infant therapeutic reunification service.

“We see children, aged 3 years and under, who have been removed from their parents because of child protection concerns,” Dr Swift tells the MJA. “I see the parents and do parenting capacity assessments, and we then see the parent with the child, then make recommendations to the South Australian Department of Child Protection (DCP), about possible reunification.”

It is not a job that is easy to do via telehealth, Dr Swift readily admits.

“It’s made reunification a lot harder,” she says. At the time of our conversation, the DCP had halted all access and contact visits for separated children and parents, due to COVID-19 restrictions.

“They’re trying to do things like FaceTime or Zoom, but an infant and a parent seeing each other over FaceTime is not really cutting it. We’re largely now just working with the parent, because the infant can’t be in the same space or can’t be transported there.”

Dr Swift has always been fascinated by babies and pregnancy, but while a career as an obstetrician seemed like an obvious choice at one stage in her training, psychiatry proved to be the perfect fit.

“I wanted to be a doctor from when I was little, as long as I can remember,” she says. “I was fascinated by it and would get very excited if we had a reason to go to a hospital to visit someone.

“Apparently, I asked my mother, what do you call the doctor who looks after little sick babies. She said it was a neonatal paediatrician, so I used to go around telling people that was what I wanted to be.”

It was a winding path which Dr Swift followed to get to her current vocation, however.

After working as a youth worker in the year immediately after high school, she went to Flinders University and started a science degree, with a thought of becoming a psychologist, but enjoyed the biology subjects more and ended up majoring in physiology and immunology. An honours year followed, in which she worked in the Department of Ophthalmology at the Flinders Medical School.

She completed her first-class honours degree at the end of 1994. Flinders University were about to start the first graduate medical school program in the country at the start of 1996 and she successfully applied. In the intervening year she worked as a research assistant in the Department of Microbiology and Infectious Diseases, a job which she continued to do while studying throughout her medical degree.

“If you had asked me on the first day of medical school what I wanted to do, I probably would have said I wanted to be an obstetrician. Again, because I love infants and babies and I was quite fascinated with pregnancy,” Dr Swift says.

“But I realised fairly quickly that the [obstetric] work I wanted to do was the work that midwives did, not the obstetrician.”

She loved emergency medicine but wanted to be able to follow up her patients. General practice was “too scary – you had to know too much”. And then in her second year she was exposed for the first time to a psychiatry ward.

“I just loved it,” she says. “I found it absolutely fascinating. Then in third year I did my first psychiatry placement and again I loved it. I just felt at home, it felt right.

“I’m also fundamentally quite a nosy person. You ask people all sorts of questions that wouldn't be okay to ask in other settings. I love knowing stuff about people.”

In her third year, Dr Swift and her partner had their first child, and by the time she was in her intern year, also at Flinders, their second had come along.

“I had a great intern year. I was busy and it was stressful. Life was full on, but I had lots of good support and good experiences.”

Her application to start psychiatry training was successful, but in those days she was required to do a year as a Resident Medical Officer before starting her training in 2002.

“I had always thought that adolescent psychiatry might be something that I did because I liked children, but I also became more and more fascinated with how the mental health services managed or saw people with a borderline personality disorder,” says Dr Swift.

“It felt like it was very much doing bandaid things and not necessarily looking at the underlying reasons and it became more and more clear to me [these sorts of disorders] developed in childhood.

“I began thinking that actually, maybe child psychiatry was where I needed to be, trying to look at prevention rather than bandaids and managing it in adults.”

Dr Swift ended up doing her advanced training in child psychiatry in 2005 and 2006 at Helen Mayo House, the Perinatal and Infant Mental Health Services section of the Women’s and Children’s Hospital.

Her first few weeks were an adjustment, she admits.

“There were all these little babies around and then they did nappy changing and feeding and stuff, I was offering to change. I think the nurses loved it because I was offering to change nappies and hold the babies. I did realise in a week or two though, that I had to do my work as well.”

A fortunate piece of timing saw Helen Mayo House receive funding for extra positions and Dr Swift went from a registrar one day to a consultant the next.

“That was an adjustment!”

Gender diversity is also a part of Dr Swift’s interests and workload.

In March 2020, she featured in an episode of the ABC show Four Corners, entitled Not a boy, not a girl, about Australian children who identify as non-binary. One of her clients, Olivia, was interviewed as part of the show.

“In my final year of training, the trainee association put on a seminar day and one was a presentation about transgender people by Dr Rob Lyons, Head of the South Australian Gender Dysphoria Unit.

“It was really interesting, so I went and talked to him at the end of the presentation and asked how could you start working in the area?

“Then around the end of my first year as a consultant, he contacted me. He needed a psychiatrist to help with adults, who needed two psychiatric opinions for gender-affirming hormones.

“As much as I love perinatal infant mental health, the idea of doing something a bit different worked well, and it was an area that had fascinated me. Rob started referring me people for second opinions.”

Dr Swift talks about “luck” a lot when talking about her career, about being in the right place at the right time, but she acknowledges there has been more to her diverse path than luck.

“I've worked hard. I was lucky enough I managed to get through my psychiatry training in 5 years, which is the minimum. I passed my exams first go, but yeah, I did work hard,” she says. “I have been open to trying different things.

“Choose something you’re interested in, that fascinates you, that you want to know more about.

“There's nothing wrong with doing RMO work or trying things out for a few years, if you're not completely sure. There might be a few areas you're passionate about, you like lots of things, you're not sure what you want to do. There's no rush.

“I actually think I'm a better doctor having had other experiences, I think. Having worked before uni and then done some other things.

“I was initially hesitant for us to have a child while I was a medical student, and there was things that were hard about it, but it was fantastic as well. What it has meant is that I realised that [doing medicine] was important, but that won't be my most important thing in the world anymore. They gave me a purpose outside of medicine.”

  • Cate Swannell


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