In a series considering the challenges and opportunities for healthcare arising from the pandemic, Dr Nnenna Osuji, Medical Director and Deputy Chief Executive, Croydon Health Services NHS Trust, reflects on the demands COVID-19 has placed on NHS teams, the inequalities it has exposed, and the value of mutual appreciation.
COVID-19 has impacted all our lives, and all the people around us. My neighbour died during the first wave of the pandemic. For a long time I did not even know she was ill, so consumed was I by working, socially isolated, and focussed on my own family when I got home.
Even the effort of saying goodbye to loved ones has been challenged by social isolation. The loss of human contact has been important and needed for the sake of public health. It will, however, be something we grapple with for some time to come. As we increasingly use digital forms of communication, we need to work harder to ensure we remain connected and express our appreciation for one another.
The demands on our NHS teams have been unprecedented, but the pandemic has shown how the whole team is vital: our porters, cleaners, caterers, lab staff, have all played crucial roles. Our team is amazing, and every single member contributes to our mission to deliver excellent care for all in Croydon. There is always beauty to be had from ashes and our enhanced ability to have mutual appreciation and respect for each other should be an example.
There has been so much happening and I suspect we will have many wounded people moving forward. This is not just about frontline staff; many administrators, cleaners, porters and catering staff have borne witness to significant traumas. It is important that we recognise the injury to and within ourselves, and don’t simply keep going.
Letting tears fall
I want to tell my NHS teams that it has been tough and that you are not alone in the tears you shed, usually silently, behind closed doors. I remember a particular case on ITU, with an extremely vulnerable young mother, her three very young children and a father who did not make it. I remember it because there were moments of hope, then despair, followed by hope again and then eventual utter despair. We did our best to let the family embrace virtually when, for understandable reasons, they could not be face to face. The scenario reduced me to tears and I found myself grieving for the family I’d never met, and the lives forever changed.
NHS staff will all have different accounts like these. COVID exposed us to illness and death at a scale and pace we have never seen before and did not allow us the time to replenish.
Now is the time for staff to talk, breathe and celebrate the things we did well. Nothing is ever perfect, but we have collectively done a great job in keeping our people safe. There was so much we did not know and learned as we went through. I am immensely proud of the way the staff in Croydon learned, shared and adapted.
Shining a light on inequality
COVID has shone a spotlight on inequality in a way that should galvanise meaningful action. Risk factors that have been shown to have an impact include age, gender, deprivation, obesity, diabetes (particularly uncontrolled), recent haematology malignancy diagnosis, organ transplant and ethnicity.
We know that if this were a matter of genetics only, we should be seeing a very different picture of COVID internationally.
Access to housing, to good nutrition, to education, to employment, to wealth, are all factors that impact our health and wellbeing. We see this in our own Croydon population. This is a cycle that we have to break. At the end of the day, we need to work on changing the things we can change and, where we can, mitigate the risks for all our patients and all our staff.
Each of us needs to look at our own unique circumstance and understand if we have any of these risk factors. There are some that are not obvious and that may be private to you. If there is something I have personally learnt, it is that I am actively going to change my own health and wellbeing behaviours (COVID comfort eating and multiple teleconferences of course have not helped!). I know I am not alone in this thinking. Speaking with a local GP, also from a minority ethnic background, he too has been motivated to start running.
Our health and wellbeing, both physical and mental is something we should actively look after. We should not forget, nor take lightly the lessons we can and should learn around prevention for ourselves, our patients and our communities. It is important we do our bit to improve health and wellbeing and reduce inequalities through every opportunity and every contact.
We are greater than the sum of our parts
Many of our staff have not been able to come into hospital to provide face to face care. Many have continued to support from afar with trials, audits, clinics, administration, remote reviews etc. The frustration of not being able to be in the hospital or clinic, seeing patients, will impact in different but still significant ways. It is important we recognise that there are differences in what we can contribute at times like this, and that these different contributions are all equally valuable. The concepts of mutual appreciation and respect around our varied contributions are key as we resume new forms of normality.
I am reminded of an extract from one of my favourite poems from my teenage years (not so long ago!), Desiderata by Max Ehrmann (1927):
“Go placidly amid the noise and the haste, and remember what peace there may be in silence. As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant; they too have their story. … And whatever your labours and aspirations, in the noisy confusion of life, keep peace in your soul. With all its sham, drudgery and broken dreams, it is still a beautiful world. Be cheerful. Strive to be happy.”
(This is an abridged version of a message Dr Osuji gave to NHS staff in Croydon on 12 June 2020)