Emergency medicine doctor Saleyha Ahsan recalls a ‘tsunami of horror’ as wave after wave of COVID-19 patients arrived at her hospital. For Saleyha, one of the most painful abiding memories is how she, and colleagues, felt ‘there was nothing at a high level that had been done to prepare us to be able to manage this’. It made her wonder how many of her colleagues would come out of the pandemic alive.
One of the most significant roles I have played as chair is to lead the BMA as a core participant at the national COVID Inquiry. It has been a huge investment of time and resource but we have always believed it vital history isn’t rewritten – and that lessons are learned. Saleyha’s testimony in this issue explains exactly why that is so crucial, speaking as she did to The Doctor as the third module of the inquiry, examining the effect on healthcare workers, their patients and the systems they worked in, got under way.
In October’s edition of The Doctor we speak to Afghan medical students whose studies were interrupted by the Taliban’s decision to ban women from studying at university but who are now attending Scottish medical schools with support from a charity called the Linda Norgrove Foundation. Bibi Hajera Safi describes their opportunity as ‘tremendous’ and adds: ‘Women are about strength. We don’t fear starting again from zero.’ These medical students’ attitudes and personal stories are incredible – I wish them the very best with their studies and future careers.
Elsewhere in this issue we sit down with GP Andrea Williamson who, as one of the founding members of the Scottish Deep End project, is doing pioneering work on ‘missingness’ in healthcare.
For too many, COVID has not gone away. Revisiting the traumas and inequalities the pandemic exposed is painful because they live on, as does the suffering of a large number of our colleagues with debilitating long COVID, and the clinically extremely vulnerable for whom the lack of precautions they still encounter, with continuing waves of COVID, is deeply distressing and isolating to them.
It is up to us to make sure no one is left behind. Everyone matters and we can be there for them regardless of where they are from or how superficially different they may seem. I hope you find as much inspiration in this edition of The Doctor as I have.
Keep in touch with the BMA online at instagram.com/thebma
Rehabilitating a nation
The UK is once again the ‘sick man of Europe’. However, this time in perhaps the most literal sense of that expression.
It was precisely this term that was employed by the IPPR’s (Institute for Public Policy Research) crossparty commission on health and prosperity, which this month published the findings of its three-year inquiry examining the link between health and the economy.
Overseen by England’s former chief medical offi cer Dame Sally Davies and Lord Ara Darzi, a surgeon and former health minister under Gordon Brown who has also recently reviewed the NHS, the report reveals an unsparing and shocking assessment of the state of the UK’s health. It says stagnating life expectancy, rising rates of chronic illness and ever-widening regional health inequalities have had a crippling effect on society and the nation’s finances.
Indeed, the economic effects of poor health cannot be understated, with the IPPR warning 900,000 people were missing from work owing to illness as of the end of last year, with this figure potentially rising to four million by the end of this Parliament on current trends.
Unsurprisingly, the report lays responsibility for this malaise, and the decimation of the NHS, squarely at the door of the policy decisions of past governments, notably the Coalition’s 2012 Health and Social Care Act. This and a decade of fiscal austerity, with the pandemic delivering the coup de grâce.
Dismal as they are, the report may come as a relief to many, exemplifying how the grim reality of what has happened to health and the NHS is starting to be acknowledged or, as BMA council chair Philip Banfield put it in response to Lord Darzi’s review: ‘Finally, someone understands.’
The IPPR’s prescription for reversing current trends is nothing less than an inversion of the dogma put forward by governments during the years of austerity;
A NEW CHAPTER
We’ve launched the first dedicated website for our content, at thedoctor.bma.org.uk . We are encouraging members to opt out of receiving the printed magazine by logging into the BMA website and adjusting your preferences. At the end of this year, for cost and environmental reasons, The Doctor will be fully digital, and the print edition will no longer be sent.
that to have a strong NHS, one needs to prioritise a strong economy.
It calls for a fundamental shift in the healthcare model from a ‘reactive, sickness-orientated 20th century healthcare system into a proactive 21st century health creation system’, something it believes can be achieved through a raft of preventive measures.
The move towards a community-centred preventive approach to restoring the nation’s health is one health secretary Wes Streeting appears to have embraced, even if the precise details as to how this will be achieved and what it will look like are yet to be forthcoming.
Speaking at the Labour Party conference in Liverpool, Mr Streeting described the NHS as ‘broken but not beaten’, qualifying this by emphasising that without reform, the health service in its current form would not survive.
He said his vision, and the Government’s 10-year plan for the NHS, was that of ‘a decade of national renewal’, one in which the NHS would metamorphose into a ‘neighbourhood health service’, a ‘digital health service powered by cutting-edge technology’ and ‘a preventive health service that helps us stay healthy and out of hospital’.
Doing so, he said, would not only ultimately improve the health and lives of individuals but boost growth by getting ‘sick Brits back to health and back to work’.
THE ROYAL SOCIETY
DAVIES: Oversaw IPPR inquiry
TORN APART
Pinak Roy loves his job as a GP but while the Government seems happy for him to care for his many patients, it won’t give the visa that would allow him to care for his own mum. Tim Tonkin reports
Health secretary Wes Streeting spoke enthusiastically of his Government’s desire to bring NHS staff, including doctors, ‘back to work and working at the top of their game’, at his party’s annual conference in Liverpool last month.
The speech, which otherwise made no reference to the issue of chronic understaffing in the NHS, came barely a week after The Guardian reported on the harrowing experience of one overseas doctor working at a GP surgery in the Parliamentary constituency neighbouring that of Mr Streeting’s Ilford North.
The paper’s report told how Pakistan-born Tajwer Siddiqui had arrived in the UK in July this year with the intention of gaining the qualifications needed to become a GP and be joined in the UK by his wife, also a physician, and daughter.
These plans were thrown into jeopardy, however, by the Home Office’s initial refusal to grant a visa to Dr Siddiqui’s 19-year-old autistic daughter, a stance which
reportedly led Dr Siddiqui to consider quitting the UK barely two months after arriving here.
While this decision was fortunately reversed, the episode speaks to a broader set of experiences concerning the challenges faced by IMG (international medical graduate) doctors attempting to forge new careers and lives in this country, not least when it comes to their families and visa arrangements.
Most infamous perhaps is the ADR (adult dependent relatives) visa process, which requires applicants to prove their relatives’ health requires long-term care unavailable in their home country and has left scores of IMG doctors and their families emotionally and literally torn apart.
Even for those who opt not to go down the ADR route, however, the experience of securing even a visitor visa for their relatives is one fraught with difficulties and uncertainty and, in some cases, has forced doctors to reconsider their futures in the UK.
ROY: Stunned by visitor visa rejection SARAH
‘Second-class citizen’
Ipswich-based GP partner Pinak Roy is just one of an undetermined number of IMG doctors who now find themselves in such a position, following the death of his father earlier this year.
Having arrived from Bangladesh a decade ago, Dr Roy wholeheartedly embraced the UK and general practice, becoming a partner at his practice as well as a GP trainer and taking up an out-of-hours care role.
As he continued to become ever more established in his career, Dr Roy took the step of becoming a British citizen and, despite the huge pressures on those working in primary care, maintains he still loves his job and the system it serves.
When BMA council chair Philip Banfield wrote to the Home Office warning of the risks restrictive immigration rules pose to NHS staffing, these concerns were dismissed by the then Conservative Home Office minister Tom Pursglove, who said there was no evidence they were deterring overseas doctors from coming to the country.
It’s an argument Dr Roy considers as frustrating as it is short-sighted.
‘I don’t feel that I’m actually being treated equally to other people in this country’
‘I’m one of those GPs who, despite all the pressures, financial challenges and work-related stresses, I still like working in the NHS,’ he says.
‘It’s an egalitarian system, and I love the fact that I don’t have to ask a patient if they can pay or not before treating them.’
After many years battling ill-health and dementia, Dr Roy’s father passed away in July of this year, leaving his wife, Dr Roy’s 60-year-old mother, widowed and alone.
To look after his mum during her time in need, Dr Roy applied for a visitor visa so he could bring her to the UK temporarily.
He was stunned when his application was rejected by the Home Office, a decision he says left him feeling like a second-class citizen.
‘It makes me feel deprived,’ he says.
‘When my dad died in July, I immediately applied for a visitor visa for my mum. She has had to look after a demented person for 10 years and this has impacted her so much [and] I knew that we need to kind of get her life together and to get her life back.
‘I just don’t understand why they’re being so thick-headed and not trying to think it through,’ he says.
‘When I first came, I wasn’t worried about my parents because I was younger, and they were healthier. As doctors, we only start to think about these things once we are older and when we are, by then, giving much more to the NHS.
‘How do I prove that my mum, while she is physically okay, mentally she needs my support? This is not something that anyone can prove, so it feels that the ADR visa rule has been made in a deliberate way so that no one can come in.
‘I can’t get her even a visitor visa when I want to, because of how unpredictable the visa decisionmaking process is.’
Dr Roy’s concern extends beyond just his personal circumstances to what his situation and experience of the immigration system might mean for other IMG doctors and the health service.
He says that, other than being separated from his mum, he is happy in the UK but that other doctors have further incentives to leave beyond escaping inhospitable immigration rules.
‘I’ll leave if this is not sorted’
‘Being a British citizen, being a passport holder of this country, I don’t feel that I’m actually being treated equally to other people in this country.’
Disincentive to stay
A survey into the effects of immigration rules and visas on IMG doctors was conducted by the BMA earlier this year and makes for alarming reading.
Ninety-four per cent of the more than 3,300 respondents to the survey said immigration rules made it less likely they would remain in the UK in the long term, with 84 per cent saying that they knew of at least one colleague who had left the NHS to care for a relative.
‘I know a lot of GPs and they’re just thinking the solution is to go to Canada, Australia or New Zealand, places where you can not only take your parents with you, but where they know they can make more money and have a better work/life balance,’ he says.
‘I wasn’t bothered about any of those things at all, but if I’m thinking about going to a different country because I cannot look after my mum, then there are so many other doctors who have other incentives to leave.
‘[If I leave] it’s going to cost the NHS much more than just losing a doctor, I’m a GP partner with 10 years’ experience, I’m a trainer and I cover emergency care as well. I’ve written to my local MP [about this issue] because I’m genuinely worried that there are a lot of doctors who are going to leave, and that includes myself as well. I’ll leave if this is not sorted.’
HOPES RESTORED
When the Taliban banned women from higher education, female medical students in Afghanistan lost their futures overnight. But a group have made it to Scotland where, despite having to start all over again, they are determined to succeed.
By Jennifer Trueland
‘Iwas at the final exams of my eighth semester. We had two more to complete – medicine and pharmacology. It was the night before my medical exam we got the news there was no university tomorrow because there was a temporary ban for women. The exams were cancelled. At first, we didn’t know how to react to the news – we were tense and stressed about the exam, so in a way we were happy [that it was cancelled] but we didn’t understand the whole scenario and what was coming. In time, we realised it wasn’t just one day, it wasn’t a holiday, it was a ban. And it affected all women in
‘I really wanted to become a doctor and help women like my mother’
universities in Afghanistan.’
This is 23-year-old Bibi Hajera Safi. The events she is describing took place three years ago – since then, her male medical student peers have finished their degrees and are working as doctors.
She, on the other hand, has at least six years to go until she gets to that point – and she is one of the ‘lucky’ ones. Thanks to the charity the Linda Norgrove Foundation, she has just moved to Scotland with the aim of completing a medical degree and becoming a doctor, like her male classmates.
She is one of 19 students whose studies were interrupted thanks to the
SECOND CHANCE: Afghan medical students in Dundee
Taliban’s decision to ban women from attending university who are now attending Scottish medical schools, supported by the charity. But it’s a huge commitment. They have had to leave their homes and their families for six years – if they were to go back while they are students, it’s unlikely they would be able to leave again. And, possibly the most galling of all, although they were a whisker away from qualifying in their home country, they now have to start all over again with an access-tomedicine course, followed by the full five-year degree programme.
‘It reminds me of that song – I don’t know if you’ve heard it – going Back to Black [referring to an Amy Winehouse track],’ she says. ‘It’s not going back to black, but to a new beginning.’
This conversation is taking place in the Tatha Café in Dundee’s V&A Museum, a striking and unusual building on the revitalised waterfront, situated next to RRS (Royal Research Ship) Discovery. Made in Dundee, this impressive vessel undertook a hazardous journey to the Antarctic in 1901 carrying Captain (Robert Falcon) Scott and Ernest Shackleton.
‘Go and study’
Bibi Hajera Safi, and her four colleagues, Soraya Ghaznawi, Arifa Wahdat, Khatera Amin, and Muzhda Iqbal, have been in Scotland for just three weeks when we meet, and are looking forward to starting lectures the following Monday. Getting here had been tough. First, they had to apply to be considered for the
IN MEMORY: Soraya Ghaznawi decided to become a doctor after the loss of her brother
‘I’ve abandoned my family and friends to come here, but I know I will find new friends’
places, then, having made it over that hurdle, they had to wait while the charity jumped through regulatory hoops to make it possible. Then –with very short notice – they made the journey to Pakistan, where they then found out they had to pass an additional language test to be admitted to the Scottish medical schools.
In the three years since their studies were interrupted, two of the five have married, and had to leave their husbands behind as well as their families.
Khatera Amin, whose wedding took place a matter of weeks ago, says her new husband was supportive of the decision.
‘It was 20 days after my marriage when I went to Pakistan,’ she says. ‘My husband has been so supportive. He is really happy I got this opportunity and said I must achieve my goal because I’d tried to do that my whole life. I really miss him, but he said, “It doesn’t matter; I’m always with you –
just go and study”.’
She has wanted to be a doctor almost as long as she can remember. When she was a child, her mother suffered severe illness, she says, but there were no doctors in the northern province of Afghanistan where the family was living at the time.
‘We had to sell our house and get her out of Afghanistan to Pakistan so that she could be treated. Because I was a child, I could see that my mother was suffering and that there were no qualified doctors. I really wanted to become a doctor and help women like my mother.’
Supported by the Linda Norgrove Foundation, she moved to Kabul and in 2019 started the first year of her clinical studies. She remembers clearly the time when the Taliban announced that women could no longer attend university. ‘I was so close to graduation. It was so shocking, so heartbreaking. I cried the whole night. I thought I had lost my hope.’
JENNIFER TRUELAND
Having successfully made it to Scotland to continue her studies – or, more accurately, to restart them – she sounds happy. ‘I feel I’m alive again,’ she says simply. ‘I have a new journey, I can start again from the beginning, it’s like starting a new life. I’m happy now and so excited to start my studies again, because it’s been three years and I sometimes thought there would be no chance for us to start again.’
Follow your dreams
Arifa Wahdat had already taken the big step of leaving her family – her father is a farmer and mother a housewife – to study in a province far from home in Afghanistan. Even that wasn’t easy. ‘My older brother always helped me and my sister to continue in our education. He spoke to my parents and told them I had my own dreams and should be able to continue my education. But it is really hard. When I was in Pakistan I felt a lot of stress about the journey – I
UPHEAVAL: Khatera Amin’s (pictured right) family had to sell their home in order for her unwell mother to receive medical treatment
DETERMINATION:
Arifa Wahdat left family and friends behind
was thinking that when I go to a different country I will face a lot of challenges apart from my family, and I don’t have any family or friends in Scotland.
‘These incredibly talented young women get their future back, with the opportunity of a tremendous education’
‘I really miss my parents and now I’ve abandoned my family and friends to come here, but I know I will find new friends and they can help me pass this difficult situation.’
It’s a similar story for Muzhda Iqbal, whose loved ones – including her husband of six months – have also encouraged her to pursue her goals. ‘They are really proud and happy that I’ve come [to Scotland] but it’s natural that we miss each member of our family,’ she says.
She was in her ninth semester when the ban on women attending universities came into force – with just three exams to pass before moving on to the practical year (a requirement of graduation). ‘I was so near to achieving my goals and completing my education –just three exams and I could be a professional doctor in
Afghanistan. It was very hard to be told we wouldn’t be able to achieve our goals.’
Having been selected to come to Scotland, she describes herself as ‘the luckiest girl’. And her goals are pretty specific. As a child, she had witnessed a situation where an aunt died because of complications in pregnancy because her family would not allow her to see a male doctor. ‘She died due to the lack of a female doctor and that made me stronger in my decision to be a doctor,’ she says. ‘When you have a special passion for something you follow your passion, and for me, the greatest thing a person can do is save the lives of others.’
She wants to follow a career in gynaecology, she says, focusing on developing countries, eventually building a private hospital to diagnose and treat poor people and provide free training for girls. It’s also her dream to be part of the Linda Norgrove Foundation. ‘It’s played a critical role in my life and the
JENNIFER
JENNIFER
life of many others. I’m pretty sure that, when I graduate, I’ll achieve all the goals.’
Family tragedy
Soraya Ghaznawi is also keenly aware of the need for more doctors in the developing world, having also suffered a family tragedy. Her brother had fallen from a roof and bled severely. ‘We lived in a village in Ghazni Province. There was no medical facility there and my parents couldn’t afford to take him to a hospital in the centre of Ghazni or Kabul, so my brother unfortunately died. This had an effect on my whole family, and when they told me about it, I thought I should become a doctor and help people in rural parts of our country.’
It took around three years of work and campaigning for the Linda Norgrove Foundation to be able to bring the students to Scotland, and even until a few months ago, it didn’t look possible. In February, the Scottish Government confi rmed student funding regulations could be amended so the women could be treated as home students, meaning they were eligible for free tuition (in Scotland). It has, the charity says, been a great effort of cooperation between the Scottish and UK Governments. The Foundation has paid all the costs of getting the students to Scotland and establishing them.
‘We’re all delighted to have fi nally succeeded after so much frustration,’ charity founder John Norgrove said as the students arrived. ‘Finally, these incredibly talented
PRIDE: Muzhda Iqbal (right) misses family members
‘A lot of girls in Afghanistan are still waiting for that chance, but we have the opportunity’
OPPORTUNITY:
Bibi Hajera Safi (left ) does not fear starting again
young women get their future back with the opportunity of a tremendous education and career. The alternative for them in Afghanistan wasn’t good.’
Even if the next six years go without a hitch, most of these women will be in their early 30s before they graduate and achieve their dream of being doctors. But they say that’s okay. ‘When
you choose medicine you don’t think about your age,’ says Bibi Hajera Safi . ‘Because your whole life is dedicated to medicine.
‘It’s a tremendous opportunity that we’ve got. A lot of girls in Afghanistan are still waiting for that chance, but we have the opportunity. Women are about strength. We don’t fear starting again from zero.’
The Linda Norgrove Foundation
The Linda Norgrove Foundation was founded in memory of an aid worker who dedicated her working life to improving the lives of others, particularly women and girls in Afghanistan.
She was kidnapped in 2010, then died in an attempted rescue by US forces. Her parents, John and Lorna, set up the foundation to continue her work.
The charity develops and supports programmes with a special emphasis on education and incomes for women. This includes providing scholarships for women studying to be doctors, midwives, and dentists. At the time that higher education for women was suspended in Afghanistan, the foundation was sponsoring 137 women studying medicine, midwifery and nursing.
Visit lindanorgrovefoundation.org
THE ORDEAL
Bungled guidance, a ‘criminal’ lack of protection for staff, and patients ‘raining from the sky’. As a new phase of the COVID inquiry gets under way, three doctors describe their experience of the pandemic. By Ben Ireland
Emergency medicine doctor Saleyha
Ahsan was seconded into ITU during the height of the COVID pandemic, working in a ‘relentless’ environment as wave after wave of patients arrived in a ‘tsunami of horror’.
When her father, 81, caught COVID, Dr Ahsan returned to London from her job in north Wales to care for him. He died a week later and within a month she was back on the front line caring for others’ family members.
This dual view of the biggest global health crisis in living memory puts Dr Ahsan in as strong a position as any to comment on the lessons that could, or should, be learned from COVID.
She spoke to The Doctor as module 3 of the UK COVID-19 Inquiry, which is examining the effect on healthcare workers, their patients and the systems they worked in, got under way.
Dr Ahsan’s reflections give a sense of how healthcare professionals, applauded from lockdown doorsteps as they risked their
lives to save others, felt isolated from and betrayed by the Government of the time.
‘I remember feeling utterly disgusted that there was nothing at a high level that had been done to prepare us to be able to manage this,’ Dr Ahsan says as she recalls when it became apparent COVID was inevitably arriving on UK shores. ‘Information and messaging was changing on an almost daily basis, which left everyone confused.’
PPE downgraded
At the emergency department in Dr Ahsan’s trust, guidance ahead of the first UK lockdown in March 2020 was for staff to wear full PPE (personal protective equipment), including FFP3 masks, surgical gowns and eye protection. But: ‘The same week, the advice coming through changed about three times. Each change meant something being taken away from our PPE. By the end of the week, it was
AHSAN: Filmed a documentary about the pandemic
just a white apron and a surgical mask.
‘There was a message, internally, that suggested we weren’t allowed to ask any more questions about it, and if you did you could potentially be disciplined.
‘Each change cited the same evidence, research on flu. I kept thinking, “Where’s the evidence for downgrading?” Everything was coming from central government. But there was no central plan. The people employed to create those systems, paid vast sums of money, failed.’
Dr Ahsan also remembers feeling uneasy with early advice to the public that dismissed the effectiveness of wearing face masks to contain the virus. She felt ‘utterly repulsed’ by comments from the then deputy chief medical officer Jenny Harries about wearing masks without the explicit advice of a medical professional being ‘a bad idea’ because of a risk of contamination.
Bungled messaging
Dr Ahsan also recalls ‘strict management’ insisting patients who were due to be discharged to care homes were not swabbed. ‘There were some really hard conversations,’ she says. ‘Nursing staff were following that instruction even if they didn’t like it. Some care home managers were begging. But it was so heavily policed.
‘I’ve never seen such micro-observations of how we were doing things, and that wasn’t just at my hospital. It was everything, from the way people were wearing PPE, the way we were discharging patients, how we created more capacity.’
The bungled, top-down messaging to healthcare workers, and the public, as well as decisions to go ahead with large events such as the Cheltenham Festival horse-racing meet, ‘all contributed to this tsunami of patients coming into hospitals’, says Dr Ahsan.
London consultant anaesthetist Kevin Fong, who gave evidence to the module 3 hearings, equated the height of the pandemic to facing ‘a terrorist attack every day’ with patients ‘raining from the sky’.
‘I remember feeling utterly disgusted that there was nothing at a high level that had been done to prepare us to be able to manage this’
Dr Ahsan describes how consultants at her hospital, and across the country, were left to re-configure clinical spaces to cope with the highly infectious and often lethal virus and ‘there appeared to be no central government leadership on this’.
‘You were thinking that at any point you could get sick,’ recalls Dr Ahsan, who caught COVID herself during the first wave. ‘You felt vulnerable, very frustrated, disgustingly grubby all the time.’
‘I was worried about my family in London. I was worried about my dad, and I was worried about my other siblings because they are doctors as well. I was worried about my brother, a doctor who is immunocompromised caring for these patients without adequate PPE. I remember thinking “How many of us are going to come out of this alive?”.’
Dr Fong, who worked during the 7/7 London terror attacks, said some hospitals were ‘bursting at the seams’ and were close to ‘a state of collapse’ in the early waves of COVID, with ‘traumatised’ staff reluctantly putting deceased patients in clear plastic sacks using cable ties because they had run out of body bags.
‘These people are used to seeing death, but not on that scale, and not like that,’ he told the inquiry. ‘Whatever the figures show you the experience for them was indescribable. It really was like nothing else I have ever seen, and certainly not like [anything] else those teams have ever seen.’
London GP Tilna Tilakkumar was a junior doctor (now known as a resident doctor) during COVID. She was recalled from a community mental health rotation to her home trust in March 2020 after an
INTENSE PRESSURE: Healthcare staff during the pandemic
TILAKKUMAR: ‘Trying to organise chaos’
outbreak on an inpatient ward for patients with complex mental health needs.
‘It was not only the lives of our patients, but the lives of our colleagues at stake because of the significant systems failings’
Within a week, she was left as the only doctor on the ward owing to other doctors’ illness, with only a ‘skeletal team’ because other staff had contracted COVID.
‘It was really just trying to organise chaos,’ she told the inquiry, noting how there was one observations machine for 26 patients. Attempts to isolate patients were ‘impossible’ and she relied on ‘word of mouth from colleagues’ for how to treat COVID patients because of a lack of top-down guidance.
Dr Tilakkumar described how PPE guidance was ‘downgraded’ within her first week on the inpatient ward, from full PPE at all times to only ‘when in contact’ with COVID patients.
This was despite treating patients who could become ‘very agitated’, ‘couldn’t be kept in their room,’ would ‘never wear a face mask’ and may also spit.
‘The moral injury continues to this day because there has been no accountability’
‘The entire ward was a COVID ward as far as we were concerned,’ she told the hearing. ‘PPE should have been worn at all times.’
Unsafe equipment
Some staff members ‘bought visors and goggles off the internet’ and others continued to wear PPE at all times against trust rules out of fear for their own safety. Dr Tilakkumar described how a visiting manager saw a healthcare assistant wearing a plastic apron, and ‘pulled it off her’.
Dr Tilakkumar had been asking for FFP3 masks for her team but was told they were only necessary in aerosol-generating procedures. She described how the wrong masks were brought to fit tests on her ward.
Testing for staff was only permitted if they had symptoms, and only 35 tests were
available per day across the entire trust. Dr Tilakkumar never had an antigen test while on the ward, but in May 2020 – after leaving the ward – tested positive for COVID antibodies.
Dr Ahsan describes how staff at her hospital were left wearing out-of-date PPE with ‘masks breaking off our faces while we were in the red zone trying to deal with very sick COVID patients’.
‘We were always up against it, dangerously so. It was not only the lives of our patients, but the lives of our colleagues at stake because of the significant systems failings.’
Staff also went to extreme measures to protect their families by isolating from them. ‘I had colleagues who were living in tents in the garden,’ she shares.
Dr Tilakkumar requested to be put up in hotel accommodation with her husband, who was working in the emergency department, to protect her parents who they were living with. This request was accepted, but the space was ‘very basic’ and ‘definitely not meant for long-term living’.
Dr Ahsan says the lack of protection given to healthcare staff during the peak of the COVID pandemic is an ‘injustice’ and ‘feels criminal because it was so avoidable’.
‘The moral injury continues to this day because there has been no accountability,’ she says.
Personal loss
Dr Ahsan’s personal loss came in late December 2020, when her father Ahsan-Ul-Haq Chaudry contracted COVID as the Alpha variant took hold – on the date of the now infamous Downing Street press conference rehearsal for how to deal with questions about parties.
‘They eventually locked down, but by that point numbers had already started to spike,’ she recalls of the period when it later became apparent that Downing Street staff were holding parties. ‘Everyone was sick and coming into hospital. The numbers were horrendous. I saw that from the perspective of the public with a sick loved one.
‘I looked after my dad in hospital, I stayed with him 24/7. The hospital allowed it because my dad had existing care at home, but I think also because they were just so overwhelmed. The situation was so desperate, everyone had COVID.
‘Bearing in mind I’d seen it all working in ITU, looking after my dad was the most frightening thing. He was 81, but a good 81.
He just deteriorated. The way it killed him was so horrendous, and so avoidable if we’d locked down properly and on time. I still get flashbacks of my distressed father, fighting to breathe. I can still hear his words “I want to die” said through the muffle of a CPAP mask.
‘Three days after he died, I had a call from the GP offering him a vaccine. That was pretty painful. That happened to so many people, then to go back to carry on working in it two or three weeks later was really quite painful.’
Dr Ahsan felt so strongly that what she was witnessing ‘needs to be seen’ that she continued to film her observational Channel 4 Dispatches documentary, even when her father was dying. ‘I was driven by that because of the power of the testimony. I had to collect this as evidence.’
Dr Ahsan’s experiences have had a ‘huge impact’ on her career since she last worked in acute settings in March 2021, she tells The Doctor.
‘I haven’t been able to fully work in that space again yet,’ she says. ‘It’s really impacted my progression through medicine. I have to go back, I don’t want to stop being an [emergency department] doctor, but I’ve allowed myself some time to recover.’
As well as making films, and other roles in medicine, Dr Ahsan has embarked on a PhD at the University of Cambridge looking into the effects of attacks against healthcare in armed conflict. She is also an active member of the COVID-19 Bereaved Families for Justice UK campaign group which, along with the BMA, is a core participant in the public inquiry.
Burnout and depression
Many doctors have seen their careers and mental health severely affected by COVID.
Dr Tilakkumar described to the inquiry how – on return to her community placement, and on rotations in obstetrics and gynaecology and general practice – she felt the care given was limited because it was so remote.
She told the hearing she has had two episodes of depression since her experiences in 2020.
‘I didn’t have any problems with my mental health before the pandemic,’ she explained. ‘[It’s] mostly from working in isolation, feeling burnt out and feeling a lack of satisfaction in my work. I don’t feel I can really help patients in the NHS these days.’
Dr Ahsan has been diagnosed with lupus, a
chronic lifelong autoimmune disease, which some studies have shown can be brought on by COVID. For her, life is also different now to how it was before the pandemic.
‘I have my pre-COVID life, my during COVID life and my post-COVID life,’ she says. ‘Life used to feel more optimistic. Maybe there was some ignorance of not knowing our government systems were not robust, and thinking we’ll be looked after at times of national crisis, but it’s almost as though our innocence has been removed. It probably is PTSD, something psychological that we need to heal from. It’s made me feel very cynical about the world and the way things are run.
‘On the other hand, I’m overwhelmed by how many good people there are – in terms of healthcare, who have worked above and beyond driven by a goal to save lives.’ You saw incredible things, people working under enormous pressure. That’s why it was so awful to see the previous Government start to attack and berate doctors, and not respect and acknowledge the sacrifices that were made.
‘Since COVID it has been really relentless, and it is hard work. It gets to the point of self-preservation. You don’t want to make yourself ill by staying in the system for a life of just burnout and betrayal.’
At least 49 UK doctors are known to have lost their lives to COVID, having toiled selflessly for their patients in the face of the pandemic.
As the BMA put it in its opening statement to module 3: ‘The pandemic has had an enormous, and in some cases devastating, impact on those working in health services, on patients, and on the healthcare systems themselves. Behind every statistic is a human story, and a deeply personal experience.’
FONG:
‘Like facing a terrorist attack every day’
‘You saw incredible things, people working under enormous pressure. That’s why it was so awful to see the previous Government start to attack and berate doctors’
COVID-19 INQUIRY
WILLIAMSON:
‘Strong sense of social justice’
A voice for the dispossessed
Some of Andrea Williamson’s colleagues at medical school joked that she ought to become a social worker rather than a doctor. For the renowned GP, it is the social determinants of health that drive her work. Interview by Peter Blackburn
The words ‘health is a human right’ greet visitors to Glasgow University’s school of health and wellbeing on a buzzing Byres Road. They are accompanied by a quote from Professor Sir Michael Marmot which reads: ‘Inequalities are a matter of life and death, of health and sickness, of wellbeing and misery.’ These are fitting mantras for Professor Andrea Williamson’s workplace. Here, the deputy lead for the GP teaching team established and runs an intercalated course on global health primary care. She also teaches and trains about the social determinants of health, inclusion health practice and trauma-informed care – as well as leading major research projects on ‘missingness’ in healthcare and other projects.
‘I grew up wanting to find out about the world – I had that curiosity and a detective-work
side to my character. And I’ve always had a strong sense of social justice. Those two things coalesce in medicine for me.’ Professor Williamson was raised in Ayrshire and was the first in her family to go to university. She studied in Glasgow, where the course was heavily biomedical and many of the students were more privileged. Some joked that she should be a social worker rather than a doctor.
Social justice
She tells The Doctor she wanted to quit on occasions but found sustenance in rare role models whose work was influenced by a sense of social justice. That was the ‘kind of doctor I wanted to be’, she says. Professor Williamson worked in infectious diseases and psychiatry after leaving university but neither was the right fit. Following that, a year working in public health in a rural hospital in KwaZulu
Natal, South Africa, brought involvement in projects such as setting up processes for the hospital blood transfusion service. Eventually, Professor Williamson realised she was a generalist at heart. She wanted to do work directly affecting communities. A range of roles including in a sexual health service where she set up a specific service for young people, academic posts and working with the homeless population followed.
In her early career Professor Williamson was working on projects about patients getting repeatedly struck off GP lists. The Doctor asks if it is frustrating that similar serious issues continue – does it ever feel like the battle is endless?
‘That’s true up to a point,’ she says. ‘But things do change. As a medical student I used to help with a third-sector organisation doing a soup run. Back then the system didn’t meet the needs
of the people there whatsoever. The only route they had for help was A&E. Now most places in the UK have a bespoke homeless healthcare service so while there’s still a lot to do things have changed.’
Yet progress isn’t always linear. Last year, local health leaders closed the esteemed Hunter Street practice, Glasgow’s hub for homeless healthcare, where Professor Williamson had worked since 2008.
Many felt it was an ‘unfathomable’ decision.
Professor Williamson, who literally helped write The National Institute for Health and Care Excellence guidelines for homeless healthcare, which underpinned services like Hunter Street, has experienced a sense of grief since.
‘It’s been upsetting – and angering,’ she says. ‘I meet patients on a weekly basis who are feeling the impact… It was also incredibly disempowering to be unable to stop it happening.’ Many of Professor Williamson’s career experiences have been empowering, though. Perhaps as much as any, a founding member of the Deep End group of GPs, a formidable coming together of doctors who work in the practices serving the 100 most deprived communities across Scotland. Having been the impetus for community link workers being set up recently, doctors involved successfully campaigned for the continuation of the link worker service, which offers support on issues such as debt, housing, domestic violence and loneliness in GP surgeries.
‘It has enabled people with a passion to be empowered, we all bring our strengths and we
‘The biggest thing is doing your job well, treating every patient you see with dignity and respect and trying to make a difference to people who get ignored or lost in the system’
support each other. There have been times I would have felt isolated without that support. But we know we aren’t on our own. And we persevere – while politicians, the civil service, and health managers change, we remain with our evidence, our experience and our knowledge.’
Missed appointments
Professor Williamson’s achievements are many, including being involved in a plethora of national advisory groups and commissions. But it isn’t those accolades she is most proud of.
‘The biggest thing is the everyday stuff – doing your job well, treating every patient you see with dignity and respect and trying to make a difference to people who get ignored or lost in the system. Those are the things that renew me.’
project looking at interventions to affect missingness running through to next year. Professor Williamson says: ‘Studying missingness in healthcare helps us understand that for some patients missed appointments have been an enduring issue. Changes to the healthcare system can change this for patients – and importantly be a way to tackle some of the pervasive health inequalities in healthcare.’
Working in inclusion health can be relentless and demanding – the difficulties and need in communities can seem overwhelming. But Professor Williamson is a ‘glass half-full kind of person’ and finds optimism in her students if ever pursuits away from work like yoga, dancing and time in the garden or with friends, fail.
‘While politicians, the civil service, and health managers change, we remain with our evidence’
In recent years Professor Williamson has been leading major research projects on missingness in healthcare, which can be defined as the repeated tendency of a patient to not take up care offers, which can negatively impact their life chances. The first part of the work, a study of monumental data sets, resulted in an award-winning paper. Its novel findings were that patients with more long-term conditions have increased risk of missing multiple appointments and were at much greater risk of death.
Perhaps most strikingly, the study revealed that patients with long-term mental health conditions who missed two or more appointments per year had an eight-times higher risk of mortality than those who attended with similar health condition diagnoses.
The work is continuing with a
‘Just this morning I was with my students and there was a person represented who was in a public space injecting heroin. A student, when explaining what the drivers were behind her being there, said “adverse childhood experiences”. I said you have no idea how happy I am to hear you make that link. These are undergraduate students with that knowledge now. I see huge energy in them and we have substantial numbers of people with those values.’
Leaving the school of health and wellbeing after time with Professor Williamson it is hard not to share some of that hope. As we exit, that maxim – ‘health is a human right’ – is visible for every talented student who walks past it. There may be many challenges ahead but there will be another generation to rise to those, just like Professor Williamson and her peers have.
You’re welcome
A ‘nurturing’ GP practice shows Seren Boyd how it seeks to reassure, gently challenge, and communicate sensitively with its patients in a bid to tackle deep-rooted health inequalities
Naila Parveen is amused; a patient has just chided her for not knowing their date of birth from memory. There are 16,800 patients on the register at the Grange Medical Practice in Huddersfield.
As reception team leader, Naila knows most of the regulars by their first names. But they expect a lot of her.
It is perhaps not surprising. Many are seeking reassurance: she is keen to help. She will often take a patient into the little side room by the reception desk if they’re struggling to understand or be understood.
She will gently encourage new patients to try to speak in English while assuring them she speaks Urdu and Punjabi.
They relate to her, especially women of South Asian heritage, not just because Naila is from their
community but because she tries to put herself in their shoes. They remind her of her mother, who arrived in the UK with no English and who has sometimes found it hard to adjust.
‘When I’m with anyone who’s struggling, I always go back to my [mum’s experience],’ Naila says. ‘You don’t judge.’
Healthcare can be daunting, especially when you lack confidence in yourself or the system. Worse still if you’re discussing it in your second or third language.
‘If you’ve gone shopping and asked for chips, and they give you a potato, it’s OK: you can just go around the aisles and look for the right thing,’ Naila explains, with her ready smile. ‘But with your health, you really don’t want to say the wrong thing or be misinterpreted.’
Health inequalities Practice manager Davinder (‘Dav’) Singh is doing an MBA and enjoys numbercrunching, but the data has been worrying him for a while.
The Grange scores highly now in patient satisfaction – but some of the stats on the local GP data dashboard are still not healthy, neither for the Grange nor the Greenwood PCN (primary care network).
Coverage for breast screening (61 per cent) and cervical screening (73 per cent) is in the red. Prevalence of diabetes is drifting higher.This is particularly concerning in the predominantly South Asian neighbourhoods of Birkby and Fartown, which the Grange serves, when South Asians are at much greater risk of developing type 2 diabetes than the general population. National health
PARVEEN:
‘With your health, you really don’t want to say the wrong thing or be misinterpreted’
‘When I’m with anyone who’s struggling, I always go back to my [mum’s experience]’
inequalities affecting ethnic minorities are writ large in these tight, terraced streets.
This area in north Huddersfield’s green belt also has sizeable white, Afro-Caribbean and Eastern European populations – and high levels of deprivation.
So, the word ‘engagement’ peppers most conversations between Dav and the team.
This week, they’re preparing for a special outreach event after Friday prayers at Masjid Riza, one of four mosques within a short walk of the surgery. Everyone’s invited but the South Asian community are most likely to attend.
Ankit Telang, who covers social media and marketing, is busy designing flyers promoting screening and health checks.
Driving this ‘health seminar’ at the mosque is Ilyas Ahmad, one of the seven GPs at the Grange.
Dr Ahmad’s been speaking to local Radio Sangam, drawing in other services, drumming up support – and he is excited.
Until early 2023, he was a single-handed GP with little time to look at biggerpicture approaches. But now that he is part of a larger team and a ‘very nurturing’ practice, he feels it is his chance to ‘make a difference’. In the colourful, airy reception space, a banner introduces him as health inequalities lead.
Dr Ahmad grew up in Birkby and has worked in Huddersfield for almost 20 years. ‘My community invested in my education, they looked after us, so now we look after them,’ he says.
PLANNING:
Dr Ahmad (left) and practice manager Davinder Singh
Preventive checks
‘Our South Asian community is quite private so sometimes they’re late in coming to us’
Prevention is to be the focus of the mosque event: breast, bowel and cervical screening; prostate cancer awareness; early detection of diabetes; free NHS health checks.
Dr Ahmad is passionate about this stuff: his own father suffered a ‘dramatic change in his health’ at a young age which, he believes, could have been prevented if symptoms had been detected earlier.
Unsurprisingly though, preventive checks can be problematic – especially on ‘private areas’ of the body – in cultures that prize modesty and chastity. Practice matron Chris Roberts often finds herself correcting misconceptions that breast screening, cervical screening, even HPV vaccines are only for the sexually active.
What is more, the purpose of these checks, says Dr Ahmad, is not easily grasped by some in his South Asian community. ‘It’s still a very common belief that you only go to the doctor when you’re not feeling well.’
Naila thinks fear also plays its part. ‘If you explain cervical cancer screening to somebody, they might say: “What? You’re saying I’ve got it?” Within Asian communities, the word cancer is massive.’
For older generations, even being seen at a surgery or clinic can suggest you are in some way ‘defective’ – and this stigma can be bad for your health too.
‘I hear it all the time: people worried about “bad vibes”,’ says Pavanjit (‘Pav’) Kaur, who’s one of three ANPs (advanced nurse practitioners) at the Grange. A close relative has just gone through a lumpectomy, chemo and radiotherapy without telling even her best friends during treatment.
Sadly, as a result, people hang back, says ANP Kathryn Iredale, who is head of nursing and quality.
‘Culturally, our local South Asian community are quite private so sometimes they’re quite late in coming to us.’
Nationally, higher rates of late-stage diagnosis for breast,
ovarian, uterine and colon cancers are reported for Black and Asian women compared with white British women.
Pav still does cervical screening even though it is not part of the ANP role; she invites the hesitant in to see the equipment and ask questions.
The Grange recently set up an online portal where patients can book a smear test with the nurses of their choice. Having nurses of different ethnicities – for those who want to see someone from their community and for those who definitely don’t – is reassuring, they tell Naila.
‘And I’m here if you need me to come in with you,’ Naila replies.
Oil, butter and chapattis
An altogether less intimate subject such as diabetes and cardiovascular disease should perhaps be easier to broach, but here too cultural complications arise.
Everyone at the practice agrees a diet rich in starchy carbs is not helping, although genetic factors also come into play. Chapattis are not the diabetic’s friend.
Pav often has to gently
HERE TO HELP: Some of the team at The Grange
KAUR: Community traditions around food are hard to disrupt
dissuade women of the idea that it’s enough just to make more vegetarian curries. ‘Actually, all the oil, butter and salt that’s gone into that curry is not fine,’ she says, ‘but that recipe’s probably been passed down three generations.’
Naila has the same challenge. ‘It is not that people won’t change; it is that they don’t know how to. Get my mum to make a feta salad, she has no idea, but she’ll spend five hours making you a curry.’
‘We work with leaders and known people in the communities so that messages are trusted’
It’s not as simple as suggesting tweaks to the family meal plan, however.
Women may have little say in the food they serve or portion size, especially if they live with their in-laws. ‘In surgery, we’re perhaps telling her: “You don’t need carbs, chapattis or rice”,’ explains Dr Ahmad, ‘but then she goes home and the whole family wants that.’
Community traditions around food are hard to disrupt too, Pav says. At her Sikh temple, she would not dare suggest changes to traditional recipes – or refuse food at langar, the meal after Sunday prayers. ‘You need a nap afterwards,’ she says.
For similar reasons, Chris has had requests for
medication to reduce fat absorption from patients preparing for weddings. She has gently declined them. Getting out to exercise is also hard for women whose role has traditionally been caregiver and homemaker, says Naila. She takes her mum out for power walks but generally, ‘women don’t get much time for themselves’.
Dr Ahmad agrees: ‘I can just go and join the gym tomorrow. But women may need permission from someone. They may be asked about what they’ll wear, why they’re going. It’s complex.’
Early diagnosis
Diabetes awareness is spreading slowly, though there is much deeper work to be done to persuade the whole community – and gain elders’ endorsement – to start shifting the stats.
Early diagnosis is key. A recent phone campaign promoting general health checks at the Grange helped unearth 70 new pre-diabetic people in the last quarter; 44 per cent of patients coming in for health checks are now Black, Asian and minority ethnic.
But it is harder to help
people with conditions they don’t or won’t recognise. Mental health issues are common in South Asian communities, says Dr Ahmad, but stigma is strong.
Naila, who was born in the UK, is fond of her in-laws and lives independently of them but joining your husband’s household can be a huge adjustment, she says. Especially if that involves moving to a new country where you don’t speak the language.
She worries about the older generation too, including those who still divide their time between Huddersfield and their country of birth: they may miss home, feel isolated, find British culture difficult. ‘They’ve got so used to hiding away it is very hard for them to open up.’
The strong family culture means people tend to lean heavily on their community for support; women may rely on others for information too.
These may be some of the reasons the South Asian community in Kirklees borough tend not to be as well connected with support services, for learning disabilities for example.
Staff at the Grange find carers are often struggling to cope alone, unaware of benefits and help they can draw on. Chris, who has caring responsibilities of her own, always asks: ‘Who else have you got living with you?’
The Grange has two designated care coordinators who connect patients with wider support networks and check in with them regularly. One of them, Tehmina Shah, speaks Urdu.
Naila has recently taken into the side room a patient who couldn’t explain what was wrong, except she was ‘finding it hard to leave the house’.
These so-called ‘complex queries’ take time and Naila’s to-do list often doesn’t get done. But Dav is understanding: ‘We are all about the patient.’
Mosque visit
‘They’ve got so used to hiding away it is very hard for them to open up’
The day of the mosque visit arrives and the team learns that Jummah (Friday prayers) will coincide with a funeral so there should be far more women attending than normal.
Mosque protocol dictates there should be separate stands for men and women, in different rooms. This will help with delivering information direct to its intended targets.
Since the idea of this event was first floated, the Grange has reached out to many different organisations and services.
Dr Ahmad is clear: the event is promoting services across the PCN and beyond. The driver behind the push to tackle health inequalities is the West Yorkshire ICB, he stresses; the Grange
can’t do this alone.
As prayers from the main hall echo across the intercom, public and voluntary sector associates share learning and ideas in a chair-lined side room.
Julie Hunneybell, health improvement practitioner (advanced), Kirklees Council’s public health team, mentions that bowel screening takeup among the South Asian community has risen since the test was changed from three samples to one.
Her research has found the barriers to screening to be complex: the word ‘breast’ on a mobile screening unit can be off-putting for some, she adds.
Julie Stein Hodgins from Pennine Breast Screening feels a more ‘inclusive or easyread version’ of the standard NHS screening invitation could more clearly spell out that the staff are female and the procedure is quick. ‘We work with leaders and known people in the communities so that messages are trusted,’ she says.
ANP Kathryn relishes these networking opportunities.
Twenty years ago, when she joined the Grange, district nurses were based in the
SEREN BOYD
IN TOUCH: Dr Ahmad addresses visitors to a mosque
building and health visitors came in for clinics. ‘Now, to reach out to the 0 to 19 team, it’s a telephone call, a referral, a task,’ she says.
But she feels there is a renewed push, post-COVID, to reconnect. ‘There’s more awareness now that people are not accessing services and a massive drive to do something about it, because the health inequality gap is just getting bigger.’
Lemons and leaflets
As prayers end, the teams take up position around the information tables.
In the women’s room, the assembled congregation cluster around to examine crocheted breasts or handle lemons, pips a metaphor for lumps. Children and bowls of curry weave around them.
There is close questioning about process and purpose – but lots of Ankit’s leaflets are secreted into handbags.
Mosque member Asiah Zulfiqar, who helped coordinate the event, is pleased with the response.
‘Generally speaking, many people are wary about having their health checks as I feel that they are afraid about any possible outcome,’ she says. ‘Reassurance needs to be given. I believe there should be more seminars like this, as many people feel safe to get themselves to open up and communicate with the health team.’
It’s becoming clear that outreach is not just clinicians telling prospective patients what to do. As Naila says, ‘you have to listen’, then respond in ways that are culturally
NETWORKING: Naila and Tehmina offer information at the mosque
‘You build a relationship and they learn to trust you’
sensitive and meaningful.
‘When I first began this journey,’ says Dr Ahmad, ‘my focus was on raising awareness and providing educational sessions. But we must also simply listen, giving voice to the people’s experiences and challenges. Hearing their stories will help us better understand their needs, provide more effective support, and create an environment of trust and empathy.’
Back at base, there are many other ideas banking and circling in the Grange’s upstairs meeting room.
The team already has an invitation to run its next health seminar at the local Sikh temple: they got in touch after hearing Dr Ahmad promoting the mosque event on local radio. The plan is to have similar outreaches regularly, rotating around different community venues.
The website now has ‘You said, we did’ and ‘Tackling health inequalities’ pages. And Dav’s considering an
‘Apple shop-style event’ where older people could be taught how to use iPads to access records or services digitally. ‘We need to think seriously about that,’ he says.
There’s no doubt he will.
Pav is thrilled her relative, who was so reticent about sharing that she was unwell, is positively enthusiastic about screening since she has had the all-clear. ‘When she went back to temple, she was telling her friends all about it,’ she says.
‘People are on a journey with us in primary care. You build a relationship and they learn to trust you. But it takes time.’
Heading back to his clinic, Dr Ahmad is adamant this is just the start. ‘If we can make a difference in one life, we’ve done our job. But we will continue.
‘Before, I felt like a seed in the grass. Dav and the team have made that seed into a plant, which is only going to spread and become a garden.’
SEREN BOYD
BECK IN TIME
Diana Beck, Britain’s first consultant female neurosurgeon, has been commemorated at her former consulting rooms. Jennifer Trueland reports
When Diana Beck was elected consultant neurosurgeon at the Middlesex Hospital in 1947, she was the fi rst woman to have been appointed as such in one of the great London teaching hospitals. Ironically, the hospital did not at the time admit female medical students.
She herself had graduated in 1925 from the London (Royal Free Hospital) School of Medicine for Women and specialised in neurosurgery, training under the great neurosurgeon Professor Hugh Cairns in Oxford. At the time, it was a relatively new and exciting specialty, and Diana Beck helped put it on the map.
Among other claims to fame, she operated on Winnie-the-Pooh author AA Milne after he had a stroke in 1952 – The Times described it as ‘a remarkable piece of surgery’.
She is known for jumping on a plane to Nigeria with just a few hours’ notice when she heard about someone who had a depressed cranial fracture – because she knew she could help. She also made an important contribution to neurosurgical treatment of intracranial haemorrhage.
Now, 99 years after she fi rst qualifi ed in medicine, she is being honoured with an English Heritage blue plaque. Unveiled on 5 September, the plaque has been installed at her former home and consulting rooms at 53 Wimpole Street, in London’s Marylebone.
Glass ceiling
in Liverpool, she fi rst became aware of Diana Beck while training at Bristol’s Frenchay Hospital. ‘One of the consultants mentioned to me that a woman had founded the unit. I was surprised about that because I’d no idea that was the case, but I had her name and did a bit of digging.’
As part of her research, Miss Gilkes uncovered Diana Beck’s obituaries from The Times and the BMJ and also found copies of papers she had written – and then she wrote her own paper in an attempt to recognise Beck’s achievements. ‘I collated this information and found out she was pretty remarkable. She’d set up the neurosurgical unit at the Frenchay and at the Middlesex and she was the fi rst female to be appointed to the staff. At the time it was a completely male consultant body, so she was probably the only female doctor in the establishment.’
She becomes one of a select few women doctors to be commemorated under the London-wide blue plaque scheme.
‘The standout achievement is that she was the fi rst British woman neurosurgeon,’ says Howard Spencer, senior blue plaque historian with English Heritage.
‘She’s a glass ceiling breaker, there’s no doubt about it. It’s sad that she died at the age of 55, because she would have gone on to achieve a lot more.’
Katie Gilkes attended the unveiling. Currently a consultant neurosurgeon at the Walton Centre
When Miss Gilkes entered neurosurgical training two decades ago, it was still relatively rare for women to progress in the specialty. ‘It obviously wasn’t as unusual as it was in Diana Beck’s day, but it was still unusual,’ she says. ‘I would say that some of the challenges I’ve found in my career have possibly been similar to hers, but not on the scale she would have experienced.’
– For more information on the London-wide blue plaque scheme, including how to nominate someone (who has to have been dead for at least 20 years) see the English Heritage website at english-heritage.org.uk/visit/blue-plaques
PIONEER: A portrait of Diana Beck
ENGLISH HERITAGE
Your BMA
Many of us are exhausted – but the BMA is here to help
I want to tell you that you’re not alone.
In recent days I’ve noticed an awful lot of colleagues seem to feel apathetic, exhausted, or even broken. Being a medical student or doctor at the moment isn’t easy. I’ve often reflected on the struggles in my role, and I hope writing about these things and sharing might help.
Perhaps it’s the change of season – as the darkness outside our home and workplaces each morning and evening seems to close in on our lives at this time of year. Perhaps we’re all exhausted after such a long period of fighting through industrial action. And, no doubt, on top of that, we all face the everyday difficulties, which should never be normalised, of pressure at work, rota struggles and a feeling that we aren’t in control of our working lives to the extent that we should be.
For many in our profession there has also been the increasing tragedy of struggling to find work, navigating our clearly broken specialty and general practice training application system – it is beyond remarkable that in a system creaking such as ours, with so much need in our communities, and a long-term workforce plan in place that crystallises these concerns, that we should be seeing GPs, resident doctors or any members of our profession left without the employment they have studied and trained so relentlessly for. It shames our system and lets down our patients. It is nothing short of scandalous.
For my part, some of the worries and struggles we all have, come at the same time as trying to be the best parent I can to two young children with a husband who is also a resident doctor juggling rotas. I haven’t taken maternity leave for my youngest and that has meant
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Email thedoctor@bma.org.uk
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The Doctor is published by the British Medical Association. The views expressed in it are not necessarily those of the BMA. It is available on subscription at £170 (UK) or £235 (non-UK) a year from the subscriptions department. All rights reserved. Except as permitted under current legislation, no part of this work may be photocopied, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical or otherwise without the written permission of the editor. Printed by Warners Midlands. A copy may be obtained from the publishers on written request.
The Doctor is a supplement of The BMJ. Vol: 387 issue no: 8448 ISSN 2631-6412
having him with me in meetings that I’m chairing and by my side all the time as I try to do this job to the best of my ability. I know these are challenges many people face whether you’re a parent or a carer or just struggling to balance work and life outside. I hope by sharing mine we can all feel less alone.
The BMA can be a source of help during more difficult times – and I would encourage anyone who feels they are struggling, that they are alone, or helpless, to contact us. We have a brilliant wellbeing service that is here 24/7 for you – 0330 123 1245. If in financial distress do consider approaching BMA Charities, the Royal Medical Benevolent Fund, the Cameron Fund or the Royal Medical Foundation among others. There is always support available and you can access it. No worry is too small.
One thing I have always believed is that – while not a solution to the systemic failings overseen by political and health leaders – activism can be a tremendous source of strength during the more difficult times in our lives and careers. For me, campaigning – raising my voice with others – can help to bring a sense that not everything is out of control, a feeling that we can make a difference.
For those of you who got involved with the BMA during industrial action, I say to you that agreements and positive ballot votes mark the beginning of a journey, not the end. Stay – continue to fight – there is so much left to do. And to everyone, I say – as I always do – get involved. There are so many opportunities to come and campaign shoulder to shoulder with colleagues from a wide variety of backgrounds for change that can benefit us all –change that can benefit our patients and our society. You can get involved with local campaigning, national branch of practice committees, our annual conferences, and so many other different avenues. And we have a BMA committee visitor scheme where you can get an insight into the work done on that level.
So, whether you’re feeling inspired, apathetic, or hopeless, the BMA is a place where you can find support and perhaps a focus – a place where there are opportunities to make a difference.
You can contact me via email at RBChair@bma.org.uk or on X @DrLatifaPatel
Dr Latifa Patel is chair of the BMA representative body
Editor: Neil Hallows (020) 7383 6321
Chief sub-editor: Chris Patterson
Senior staff writer: Peter Blackburn (020) 7874 7398
Staff writers: Tim Tonkin (020) 7383 6753 and Ben Ireland (020) 7383 6066
Scotland correspondent: Jennifer Trueland
Feature writer: Seren Boyd
Senior production editor: Lisa Bott-Hansson
Design: BMA creative services
Cover photograph: BMA
Read more from The Doctor online at thedoctor.bma.org.uk
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