A Certain Darkness is Needed to See The Stars by Sarah Gemmell

There are only two certainties in life, being born and dying.

Sadly children are not exempt from the latter.

Coming into a profession like nursing or medicine, the main drive for a lot of people is to make people better and to send them home. Thankfully for us in paediatrics, this happens for the majority of our patients, there is nothing better than seeing little ones recover and wave us goodbye as they leave the ward. On the occasions that this does not happen, it is heartbreaking for everyone involved.

Over my 22 years of nursing, I have experienced a number of child deaths, each one completely different. I feel it is fair to say that even though the team have the best intensions and always want to do their upmost for each patient and their family, we don’t always get it quite right, but is there such a thing as a “good death”?

We know that not getting it quite right is just not acceptable. We want to make sure that every child who is at the end of their life is given the best possible care. Families should have access to the highest level of support. We recognised that we need to have processes in place for this to be achieved.

In 2019 the CAPELLA team was created. CAPELLA stands for Community And Paediatric End of Life Linked Attributes team, it is also the brightest star in the sky. The team’s aim is to provide care and support to patients and their families in the last few weeks of the child’s life, in the environment that they choose. This could be at home, in the children’s ward or in one of the Children’s Hospice’s Across Scotland (CHAS).

The team consists of registered nurses and health care support workers from the acute children’s ward and Community Children’s Nursing team and a local paediatrician. The team work closely with CHAS to be able to provide some level of support, 24/7, in a way that the patients and families need. Unfortunately, it is not always possible to have nursing care face to face at every moment; however we strive to provide as much as we possibly can. We have also been extremely fortunate and are exceptionally grateful to the adult community services that can, when appropriate, help to support us too. The CAPELLA team will do their best to listen to the wishes of each patient and family which means the level of support may vary, dependant on what it is they ask for. There is a mix of face to face and over the phone support.

The nurses and health care support workers strive to provide the best nursing care for the patient, and/or support the families to be able do this. They administer medications, provide basic cares, allow families to have a break, support with any other children in the home and even make cups of tea or assist with anything around the home or simply be at the end of the phone if it means we can make this devastating time a little easier. The paediatricians are there to provide guidance and support to the patients and families, taking the lead from the families, and ensuring they are equipped with all the information they need and request. CHAS help to guide and support us and where possible provide nursing care in the home or at one of the hospices.

For me, being able to be at the forefront and providing the hands on support or being in the background to co-ordinate these processes, both equally as important as the other, it has been the most privileged experience of my career. I am extremely humbled to be able to try and allow families to have influence and control over the uncontrollable.

We are very fortunate to have been donated 2 supplies boxes so that we have an adequate amount of equipment stored safely when going into homes. These boxes were donated by the McQueen family in memory of little Tyler McQueen, a beautiful little lad who we cared for just before the CAPELLA group was started.

We have also been fortunate to have amazing memory boxes created and provided for use in Dumfries and Galloway by the Cranston family, in loving memory of Beri Cranston, a most precious and beautiful baby girl. The memory boxes are there for any family who lose a child. They are considerate of all ages and circumstances. There are other memory boxes available nationally from SANDS and SiMBA charities, these boxes are provided to families who have lost a baby.

The CAPELLA team are also there to support any family throughout their bereavement journey, inclusive of those we have had no prior involvement with. We can be contacted via email dg.capella@nhs.scot with any queries to assist with things like questions about where to find support moving forward. We are in the process of developing an information leaflet titled, “When Your Child Has Died, Information for You”. The purpose of the leaflet is to help guide families through what I am sure may be a very confusing and heartbreaking time, pointing them in the direction of support and providing advice.

The health professionals who support patients and families also need support. The CAPELLA team recognise this, which is why we ensure that all those professionals who are involved or have been affected are offered ongoing support and counselling. We always ensure staff are offered the opportunity to attend a debrief session where there is safe space to share their experience and feelings.

Is there such a thing as a “good death”?

 I say yes, with an amazing team and clear processes in place, we can make a massive difference to patients and families at such a devastating time.

Sarah Gemmell

Advanced Paediatric Nurse Practitioner/Paediatric Epilepsy Nurse Specialist

Supported by:

Sarah Murphy

Deputy Charge Nurse, Paediatric Ward

Dr Eccleston, Paediatrician

The Pale Blue Dot by Carl Sagan

On Feb. 14, 1990, famed scientist Carl Sagan gave us an incredible perspective on our home planet that had never been seen before.

As NASA’s Voyager 1 spacecraft was about to leave our Solar System in 1989, Sagan, who was a member of the mission’s imaging team, pleaded with officials to turn the camera around to take one last look back at Earth before the spaceship left our solar system.

The resulting image, with the Earth as a speck less than 0.12 pixels in size, became known as “the pale blue dot.”

Voyager 1 had already finished its primary mission of studying Jupiter and Saturn towards the end of 1980, but its mission was extended — and continues to this day — so it could study the far reaches of interstellar space.

The striking photograph almost never happened. Early on in Voyager’s mission, Sagan had tried to get the look back at Earth, but others on the team worried that the Sun would end up frying the camera. But eventually, with the mission winding down, Sagan finally got his wish — a last minute Valentine’s Day gift in 1990.

Here’s what he wrote:

“From this distant vantage point, the Earth might not seem of any particular interest. But for us, it’s different. Consider again that dot. That’s here. That’s home. That’s us.

On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives.

The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every ‘superstar,’ every ‘supreme leader,’ every saint and sinner in the history of our species lived there – on a mote of dust suspended in a sunbeam.

The Earth is a very small stage in a vast cosmic arena. Think of the rivers of blood spilled by all those generals and emperors so that in glory and triumph they could become the momentary masters of a fraction of a dot. Think of the endless cruelties visited by the inhabitants of one corner of this pixel on the scarcely distinguishable inhabitants of some other corner.

How frequent their misunderstandings, how eager they are to kill one another, how fervent their hatreds. Our posturings, our imagined self-importance, the delusion that we have some privileged position in the universe, are challenged by this point of pale light.

Our planet is a lonely speck in the great enveloping cosmic dark.

In our obscurity – in all this vastness – there is no hint that help will come from elsewhere to save us from ourselves.

The Earth is the only world known, so far, to harbour life. There is nowhere else, at least in the near future, to which our species could migrate.

Visit, yes. Settle, not yet. Like it or not, for the moment, the Earth is where we make our stand. It has been said that astronomy is a humbling and character-building experience. There is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world.

To me, it underscores our responsibility to deal more kindly with one another and to preserve and cherish the pale blue dot, the only home we’ve ever known.”

Carl Sagan

Drug and Alcohol Festive Season Awareness by Jacqueline Stewart

The countdown to Christmas is on, and for many the celebrations have begun; with Christmas parties, boozy Christmas lunches and mulled wine at the Christmas markets. Alcohol is synonymous with the festive season – the prospect of having a drink is everywhere you go, with people letting their hair down, enjoying the celebrations, and often over-indulging. Everything is merry and, well potentially blurry depending on how many units you have consumed.

What if you aren’t drinking?

“Why aren’t you drinking?”

“Come on, I am sure you can have a couple”

“So you’re not drinking… does this mean you are pregnant?”

For those trying to stay alcohol free, it can seem almost impossible to avoid it when you are surrounded by it. Let alone when you are being constantly interrogated about it.

It is not just alcohol that is all around us this time of year. Despite being illegal, many people may use recreational drugs when celebrating throughout the festive season, with ‘party drugs’ and other unknown substances popping up at nightclubs, parties and bars.

Celebrations are not the sole reason for drinking alcohol and/or taking drugs. This season may be seen as a joyous time spent with family and loved ones, but it can also be seen as a reminder for grief and loss. For those without family, either due to death or estrangement, or those whose homes are not a safe space; the season can be long, lonely, overwhelming and potentially dangerous. The stresses and strains of the festive season can affect us all, but primarily can bring problems with addiction to the fore. We all try to cope in our own ways, but for those who struggle with addiction, the temptation to drink alcohol or take drugs as a coping mechanism is huge.

Scotland is facing a public health challenge with the highest level of drug deaths in Europe and one of the highest alcohol death rates in the UK. In 2021, 1,330 people died from taking drugs and 1,245 people died through an alcohol specific death. As a collective, we need to do whatever we can to reduce the stigma of addiction and support those around us to reach out for help, all year round – but particularly in times when addiction hits hardest.

We cannot change other people, how they act or what they do, but we can change how we respond. For other health conditions many know the important signs and symptoms of heart attacks, strokes, choking and allergic reactions; along with information on what to do in these situations. All of which are incredibly important first aid methods that can save a life.  

But what about the signs of a drug overdose or the signs of alcohol poisoning? Would you know what first aid to do in these circumstances that can also save a life?

Signs of alcohol poisoning

Alcohol poisoning occurs when a person drinks a toxic amount of alcohol, usually over a short period of time. Being poisoned by alcohol can damage your health or even put your life in danger.

The signs and symptoms of alcohol poisoning include:

  • confusion
  • severely slurred speech
  • loss of co-ordination
  • vomiting
  • irregular or slow breathing
  • pale or blue-tinged skin caused by low body temperature (hypothermia)
  • being conscious but unresponsive (stupor)
  • passing out and being unconscious

In the most severe cases, alcohol poisoning can lead to coma, brain damage and death.

If you suspect alcohol poisoning, dial 999 immediately to request an ambulance.

While you’re waiting:

  • try to keep them sitting up and awake
  • give them water if they can drink it
  • if they have passed out, lie them on their side in the recovery position and check they’re breathing properly
  • keep them warm
  • stay with them

Never leave a person alone to “sleep it off”. The level of alcohol in a person’s blood can continue to rise for up to 30 to 40 minutes after their last drink.

 This can cause their symptoms to suddenly become much more severe. You also should not try to “sober them up” by giving them coffee or putting them under a cold shower. These methods will not help and may even be dangerous.

Signs of an overdose

Most overdoses are witnessed; therefore it is essential to recognise the signs and symptoms of an overdose in order to respond.

Some of these symptoms include:

  • Pinpoint pupils (this indicates whether opioids are involved).
  • Breathing problems (e.g. slow/shallow or infrequent breaths, snoring/rasping sounds or not breathing at all).
  • Pale skin colour. Lips, tip of nose, fingertips or nails with a bluish tinge.
  • No response to noise (shouting) or touch (shoulder shake).
  • Loss of consciousness

What you can do:

  • Call 999 straightaway
  • If available and you believe it may be an opioid overdise, administer naloxone
  • Put the individual in to the recovery position
  • Stay with the individual until emergency responders arrive

What you know and what you do about overdose could make the difference between life and death. If you believe someone is having an overdose, DO NOT inflict them with pain, inject them with a stimulant, put them in a bath/use cold water or attempt to walk them around. These myths are not effective and can cause further harm.

Naloxone Drive 19th of December

If you are interested in being trained in how to use Naloxone, the Alcohol and Drug Partnership, We Are With You and the Focus Wellness and Recovery Hub are working in partnership to deliver Naloxone Drives in Dumfries and Stranraer.

Naloxone is a medication that temporarily reverses the effects of an opioid overdose. Naloxone saves lives.

These drives are open to everyone, whether you take drugs yourself, are a family member or friend, or a professional who works closely in the drug and alcohol field.

Naloxone Drive Dumfries:

We Are With You, Buccluech Street:

10:00am – 12:00pm

and

4:30pm – 6:30pm

FOCUS Wellness and Recovery Hub (formerly Lochside Clinic), Shirley Road:

1:00pm – 4:00pm

Naloxone Drive Stranraer:

We Are With You, Charlotte Street

10:00am – 4:00pm

More information about some of the resources and services that are available to help drug and alcohol users can be found on the Dumfries and Galloway Alcohol and Drug Partnership website at https://dghscp.co.uk/alcohol-drugs-partnership-adp/

Training during a Pandemic by Lisa Johnstone & Bryan Gray

We commenced our Specialist Community Public Health Nursing (SCPHN) (Health Visitor) training in September 2021 with The University of the West of Scotland. We have continued to feel the impact of the covid-19 pandemic throughout our training, having to adopt a blended method of learning, whereby we do the majority of our learning via MST meaning we have attended university only a handful of times. During our practice placements, we have adopted a hybrid method of working and have so far managed to overcome the challenges presented to us. The support we have received from all of the Health Visitors and the wider multi-specialities who supported our alternative practice has been invaluable. The last year has been very challenging due to the demands of master level study, and at times it has been difficult to find a work life balance, but all of the sacrifices have been worthwhile.

Nearing the end of our Trainee Health Visitor journey, Bryan and I have had the opportunity to develop our knowledge and skills surrounding child development and the profound impact the early years can have on the current and future health and wellbeing of children across Dumfries & Galloway. As future Health Visitors, we will play a pivotal role in supporting children and families in the first few years of a child’s life, navigating our way through the Universal Health Visiting Pathway.

A fundamental component of our future role as Health Visitors is collaborative working; engaging with multiple professionals ensures that any observed health or wellbeing needs are identified early, enabling prompt intervention and support from the appropriate professionals/teams, for example, Speech and Language Therapy

NHS Education for Scotland recently published an interactive resource titled ‘Speech, Language and Communication: Giving Children the Best Possible Start in Life’ this resource works in line with the schedule of home visits laid out in the Universal Pathway.  There is information on expected speech, language and communication development at key points in a child’s development, alongside areas of reflection on the role of the Health Visitor and strategies and interventions to promote speech, language and communication for children aged 0-5 years.

Available at: https://slctoolforhv.nes.digital/the-health-visiting-pathway.html

Compassion with Knowledge by Nick Walker and Ben Rayen

“When patients go to a doctor, they do so because they feel that the doctor is the person with the best chance to help them. They may be alternating between hope that the doctor will be able to cure them, and fear that nothing can be done. When the doctor demonstrates that they really care about the patient, it can immediately help put their mind at ease” Medicine and Compassion. Chokyi Nyima Rinpoche and David R Shlim.

Nick and Ben share some thoughts on their experiences as doctors,

Nick

How long have you been a doctor?

I grew up in New Zealand and qualified there before travelling a bit.  My plan was to return to complete specialisation in psychiatry, but I ended up staying in Scotland when I met my partner, and trained in psychiatry in Glasgow, Ayrshire and Aberdeen.  Next week will be the fortieth anniversary of my last day at school; I qualified in medicine just over 34 years ago. I’ve worked in psychiatry almost 32 years and as a consultant since the start of this millennium.  

Ben

How long have you been a doctor?  

I graduated from India and have been practicing medicine since 1995. I have always had Paediatrics as my core interest and started to develop my interest in Paediatrics since very early during my medical training.

Before coming to the UK, I completed 3 years of postgraduate Paediatric training from one of Asia’s biggest children’s hospitals, The Institute of Child Health, and received my MD graduation there in 2001.

I came over to UK to pursue further training the same year, went on to work at the Alder Hey, Birmingham Heartlands, Yorkhill, St Mary’s Manchester hospitals etc to name a few and then settled down in Dumfries for good. 

Nick

What is your ideal doctor?  

Long ago I learnt that perfection is unattainable; more recently I realised it’s undesirable too. Being imperfect is part of being human. Accepting these counters, the constant stress of striving to be perfect and worrying about not making it. Owning some imperfection, some room for error, is part of what makes a doctor come across as human. It makes it easier for others, for patients and their loved ones, for colleagues because they identify with that touch of fallibility. Being honest about this, reflecting on mistakes – and on good clinical decisions whose outcomes are not quite as hoped or expected – with patients, families, staff, peers really humanises the medic which in turn makes it easier to achieve the balanced, collaborative relationships at work which help make an ideal human being, and an ideal doctor. 

Ben

What is your ideal doctor? 

For me, in whatever profession we decide to pursue, we need to love it and be passionate about the job we do. 

As a doctor, I feel we are in a good position (responsible position) to make others’ lives better. I always look forward to the joy of seeing someone getting better, especially children.  

Children are different, they are very withdrawn and low when unwell and also, they find it hard to meeting a stranger like us in the hospital. However, once treated they bounce back superfast. They are back to their normal self, all over the place, chatty, smiling – these are a joy to watch, I love seeing them this way. 

This provides a doctor an immense pride, self-belief, positiveness and addiction to do such acts more. 

As a doctor, I feel with the evolution of medical management every few months, we need to constantly learn, change and develop ourselves to suit the needs of the patients of the current times. We need to have a very flexible approach rather than just stick with our own thoughts, being adaptable rather than how we were taught earlier in our training. Some of these teachings might not fit the current practices or fit for purpose for the current generation, but we can listen, change and adapt!  

Nick

What is compassion? 

To me, compassion is intentionally listening (really listening) – curiously, to understand – and then accepting without judgment, even if you disagree; and being thoughtful and wise in how to respond. And it to yourself as well as to others. 

Ben

What is compassion?  

For me compassion is all about how can I help here? How can I make it better for the patient, colleagues, or anyone else, trying to find ways to listen to them and solve their issues. How we deliver care is through relationships based on empathy, respect and dignity, it can described as intelligent kindness, and is central to how people perceive their care. 

Nick

Why does compassion matter?

Compassion matters for many reasons. In medicine, it is part of what makes an ideal yet imperfect doctor.  It matters for patients because even in very challenging cases, they feel understood, their experiences validated. Then working together, even when treatment options might be few and of limited effect, becomes a joint process for decision-making and a shared, supportive clinical experience.  For teams and colleagues, compassion matters for similar reasons. Positive contributions aren’t invisible; they are noted, commented on, welcomed, encouraged.  Questions – no matter how “silly” – and less wise decisions can be talked through and learnt from calmly and without trepidation, not avoided but turned into opportunities to learn and improve. Being compassionate models a compassionate approach; consulting someone who takes a compassionate approach feels comfortable and fosters further compassion. In its small way, this virtuous circle helps counter the shoutiness of life – and social media, and politics – in this modern age.  

Ben

Why does compassion matter? 

In my dual role as a doctor and as an AMD/CD compassion is something that has to be part of everything I do and with any of my decision making. I will respond more here on the leadership role as I have provided more info earlier as the role of an ideal doctor. 

For me, the leadership role I do will always be a collective and a compassionate leadership. It is all about the people I work with, I will make sure everyone has a say and they take responsibilities. I have always tried to be there, respond to queries in a prompt way instead of leaving it to develop into a bigger issue. I try to create a positive and supportive environment and make colleagues flourish and grow. Increasing demand and complexities causes challenges, and this is a well-known factor for stress. 

I like to be part of and contribute to solution making. Even when my best solution is to listen.

Young Nick

Ben

“When we are motivated by compassion and wisdom, the results of our actions benefit everyone, not just our individual selves or some immediate convenience.” Dalai Lama

Nick Walker

Associate Medical Director Mental Health

NHS Dumfries and Galloway

Ben Rayen

Associate Medical Director W&C’s Directorate and Clinical Director Paediatrics & Child Health

NHS Dumfries and Galloway

Becoming a Flying Start Facilitator by Laura Houston

I started the NMAHP Flying Start programme at my previous job within NHS Ayrshire and Arran, where newly qualified practitioners (NQP) within the Allied Health Professions (AHPs) are encouraged to complete the programme to aid the transition from student/graduate to working as a fully qualified healthcare professional. I then started my new job at DGRI, NHS Dumfries and Galloway, where I completed my final unit and then became a Flying Start Facilitator, mentoring a NQP through the programme.

Completing the programme was very useful with regards to continuing professional development. It allowed me time to reflect on my clinical practice which I otherwise would not have been able to do; this in turn allowed me to feel less overwhelmed as well as allowing me to provide the best possible person-centred care to service users. Flying Start has allowed me to encourage the facilitation of learning in the workplace with regards to colleagues and students as well as the NQP I had mentored through the programme; and it has allowed me to be more mindful of supporting those requiring assistance in the workplace. With regards to leadership, I was able to put my knowledge into practice when I have been supporting students on placement within the x-ray department, as well as new staff members. I have also participated in calls with a group of NQPs to share my Flying Start experience with them and provide feedback on their ideas. Finally, Flying Start has inspired me to constantly think of new ideas to aid improvements in the workplace through the use of new audits and being more confident in sharing my ideas with others, thus creating evidence to improve practice and services.

Mentoring a NQP through Flying Start was very manageable for me: they would email me any queries they had then they would send me their documents to read and feedback to them when each unit was ready to be signed off. After signing my first NQP off for completing the Flying Start Programme, I am really looking forward to mentoring someone else who is keen to complete the programme. Flying Start within the x-ray department isn’t generally promoted, so I am aiming to make more people aware of the valuable skills gained and opportunities that can arise as a result of completing the programme.

Laura Houston, Diagnostic Radiographer, Imaging (x-ray dept), DGRI, NHS Dumfries & Galloway.

Email: Laura.houston3@nhs.scot

The Power of Movement by Emma Miskimmins

It is no secret that COVID-19 has impacted everyone one way or another and that our NHS services have been (and continue to be) pushed to the absolute limits.

Although it is clear that COVID-19 is not yet a thing of the past, we are beginning to move forwards and learn to live alongside this virus.

In order to move forwards successfully, and to improve the current circumstances for health and social care and most importantly, its service users – we must tackle the major issue that is deconditioning.

An article by Pubmed (2005) describes it as “a complex process of physiological change following a period of inactivity, bed rest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living. It is frequently associated with hospitalisation”.

The lockdowns that have occurred as a result of COVID-19, plus the anxiety of potentially catching the virus, has resulted in a large number of the population staying at home, becoming less active and as a result, becoming deconditioned.

Ironically this has led to a multitude of other issues, including increased admissions (particularly with the older population) putting more pressure on the health and social care system than ever before.

But why?

Inactivity reduces our muscle strength and exercise tolerance, however, it does so much more than this, especially the older we get.

Decreased levels of activity and movement can result in:

  • Inability to carry out ordinary daily tasks, increasing our dependence
  • Issues with incontinence and skin problems e.g. pressure sores
  • Significant increase for risk of infection
  • Significant increase in chances of developing a multitude of co-morbidities such as heart disease, depression, cancer, dementia etc.
  • Significant increase in risk of falls, in turn increasing the risk of e.g. fractures

And that is only a few examples, each one making the chances of developing the others higher and higher. All of the above also greatly increases the chances of a prolonged hospital admission. A hospital admission reduces the need and motivation to be active and to move, therefore the risk of further deterioration and further deconditioning increases, resulting in a vicious circle for both service user and health and social care services which is extremely difficult to break.

So what can we do?

This obviously is very individual and depends on a persons’ abilities and circumstances, below are just some examples.

Within the community –

  • Any movement is better than no movement, try using an interest or hobby as a motivating factor – e.g. gardening, swimming, walking, cooking/baking etc.
  • Making small changes – try making a point to get up every hour for a small walk and stretch – this is particularly important if spending the majority of the day sitting or if you have decreased functional abilities.
  • Encouraging loved ones, friends and family to participate in movement.
  • Reducing risk of falls – wearing proper supportive footwear, uplifting rugs, cables and clutter that may get in your way during movement.
  • Seeking out community activities – a great way to keep up with or learn a new hobby and also met new people.
  • Accessing support at the right time – if your activity levels have decreased for any reason and you are now finding it difficult to get around, it is important to let your health provider know. They can help figure out why this has happened (examples could include; low mood/anxiety, social isolation, increased levels of a sedentary lifestyle due to COVID, illness/injury) and get you the right support at the right time. Research shows early intervention and prevention is critical in maintaining independence and reducing risk of illness, injury and hospital admissions.

During a hospital admission –

  • Ensuring if you are able to, keep as active as possible. If you are unsure about getting up/moving by yourself – please ask staff who will advise you on this and also exercises you could be completing to help you stay active and strong. All staff should be supportive of keeping active during your hospital stay.
  • Wearing your day clothes – hospital does not mean you need to wear your pyjamas all of the time. Comfortable clothes such as leggings/joggers etc are advised however, pyjamas should be kept for night time only. Get Up! Get Dressed! Get Moving!
  • Sitting up out of bed (especially when eating and drinking!)– whilst it is recognised you may be more fatigued whilst in hospital due to recovering from illness or injury and you may need a rest in bed at some point during the day, it is important that you sit up out of bed as much as possible during the day otherwise. This will help you maintain strength and reduce your risk of developing things like DVT’s and chest infections.
  • Sticking to routine – this is important to help us feel more “normal” and therefore likely to be more motivating to get up and get moving. It is particularly important to maintain a good sleep routine.
  • Bringing things to keep you busy such a books, wordsearches, puzzles etc. This will help prevent falling into bad habits such as sleeping for prolonged periods of time during the day.
  • Bringing in appropriate and supportive footwear that you can walk well in.
  • If you have been referred to Occupational Therapy and/or Physiotherapy, ensuring you engage with your sessions as much as possible will help to support your activity levels and also increase/maintain your independence.

By completing all of the above, you have a much greater chance of reducing the length of your hospital stay and recovering quicker!

(Office for Health Improvement and Disparities 2022)

For more information on how to stay active at home and within hospital, please visit the NHS website: https://www.nhs.uk/better-health/get-active/

Alternatively, for further support and information, contact your GP or if already referred to an allied health professional (OT, Physio, community nursing, podiatrist, dietician, speech and language therapist etc) they will be able to support with this also.

Get Up, Get Dressed, Get Moving!

Is the message we’re trying to Share

But why should I get moving?

I’m in hospital!

Don’t you care?!

I feel poorly, I feel weak, I just wish to lie in bed

I need sleep to feel better,

Now let me rest my head!

I don’t like the hospital, I want to go home

I’ve already done my therapy,

Now please, leave me alone

The OTs, the physios, the nurses,

They do their very best,

To get you up and moving

And independent again

But this isn’t enough you say, surely not,

Tell me why…

Not moving for long periods is bad for me you imply?

Not moving for long periods can reduce your independence,

It makes you weak, it makes you tired, it will increase your dependence!

You’ll end up with us longer,

Your therapy will be harder,

It increases your chance of your health deteriorating faster

So please,

Don’t think you’re bothering, or causing too much hassle

Get Up! Get Dressed! Get Moving!

You’ll certainly recover faster

Emma Miskimmins is an Occupational Therapist at the Galloway Community Hospital

A GP’s response to Scotland’s health and care data strategy by Rob Walter

This blog was first published on FutureScot on 11th August and can be seen at https://futurescot.com/getting-the-best-out-of-patient-data-is-key-to-unlocking-future-health-benefits-in-scotland/

It is important that clinicians’ voices are heard in the consultation around Scotland’s new health and care data strategy, which closed recently (12th August).

Busy GPs like myself are the trusted gatekeepers at the coalface of healthcare.

We have first-hand knowledge of just how important it is that the right information is available to the right clinician at the right time, wherever the patient interacts with health and social care services.

What then can the new data strategy do for me that might improve patient centred care? 

A legacy of trust

An early step in healthcare data access was the successful introduction of the national Emergency Care Summary by NHS Scotland in 2006. This allowed patients to consent to access to their health data at the point of care delivery, rather than consenting in advance for data upload.

It was widely accepted and trusted by the profession and patients alike, with high uptake compared to other nations’ summary care records and provided out of hours and emergency care access to prescribing and allergy records.

We need to build on that and the trust the public have given us with their information.

We’ve come a long way since 2006. Electronic patient records have become richer and technology has developed to allow multiple users involved in a patient’s care to share it and input data.  Patients themselves can also choose to share data captured by personal devices such as smartwatches.

This huge growth in information brings many more opportunities to improve both individual and population health. But we also risk losing important details amongst a tsunami of information

Risk of information overload

It is essential the systems we use are both intuitive and help guide the user with structured data capture.

We need to be able to handle the volume and present it in a concise and meaningful way, surfacing the current abnormal above the background noise and giving clinicians evidence-based resources and treatment pathways.

The end goal must be that data can be amalgamated and analysed in its entirety so that clinical decision support works across the whole patient record and not just in ‘my view’ of it.

Technically, there are many ways to achieve this but for me the key components are:

  • interoperability (systems talking to other, using standard FHIR (Fast Health Interoperability Resources) messaging);
  • retaining a diversity of systems to meet the different requirements of different areas of medicine and social care;
  • Maintaining confidentiality and integrity through strong role-based access that ensures universal understanding of what is and isn’t allowed to be viewed by specific users in role, whilst ensuring clinical safety in the background.  This is imperative if we are to retain patients’ trust.

The importance of clinical coding

To mobilise this data requires standardised coding. Historically, primary care has relied on the READ V2 coding system which has served its purpose and has now been retired. The future is SNOMED CT – an international coding language that has a UK specific version.

It is a much richer code set that is well structured and uses ‘semantic tags’ to help categorise types of codes. For the end user, choosing coded information is simply a case of searching for terms, or with good clinical systems, automatic presentation of the best terms to use in a structured manner.

Once we achieve all of this, we will be delivering a high-quality data set which we can then interrogate and learn from.

High-quality data will drive better care

A rich, comprehensive, and accurate data repository that can be analysed in near real time offers so much for the health service in Scotland.   

For example, machine learning algorithms can identify patient cohorts who would most benefit from intervention – allowing us to target our limited health resources to those most in clinical need. 

High-quality data can also drive valuable research into new treatments and medicines, and this is recognised as a key part of the vision for Scotland’s new data strategy.

The consultation paper rightly highlights that we must tread very carefully – using health and social care data ‘for the public good’ and adopting a transparent approach to reassure the public that their data is being used appropriately.

Dr Walter is a GP at the Gillbrae Medical Practice in Dumfries, and clinical intelligence director at EMIS, which provides clinical systems to more than half of GP practices in Scotland.

My Journey to Return to Practice as an Occupational Therapist by Shona Sneddon

I qualified as an Occupational Therapist back in 1994!!! And enjoyed a career in physical OT working at what was then the Southern General Hospital in Glasgow and then in a Community Paediatric OT Team in Lanarkshire for many years. I was then fortunate enough to return to beautiful Wigtownshire and have the luxury of a 4-year career break focusing on the job of being a full-time mum to my wonderful children. When it was time to return to the world of work I had a decision to make, return to OT or try something new? I opted for the trying something new and spent 9 ½ years working as a Dementia Advisor and Carer Liaison Worker with Alzheimer Scotland, an extremely enjoyable but challenging job giving me the privilege of working and sharing the dementia journeys of many wonderful people and their families. This allowed me to use many of my core OT skills and also gain new skills and experience.

Then COVID happened and like many people I began to re-evaluate my career and the idea of returning to OT practice, which I had been considering for some time started to become a reality. It all started during conversations with Wendy Chambers D&G Dementia AHP Consultant and Laura Lennox D&G AHP Practice Education Lead. Laura made contact with Jacqui Pike Occupational Therapy Service Manager who kindly agreed to meet with me and discuss the process of returning to practice. Following that initial meeting Jacqui arranged to discuss this with the OT team and look into the possibility of creating a fixed term Return to Practice post for an OT within the D+G Mental Health OT Service. This all happened in May 2021. While I was waiting to hear about the return to practice post I started the daunting task of completing my 30 days private study required for return to practice.

I have to admit this was hard work while still working 31hrs a week and a mum of three children. I could not have done it without the help and support of my husband and children, all the meals prepared housework and dishes that were done not to mention dog walking!! However by December 2021 this was completed and following a very nervous interview I was offered Dumfries and Galloway’s first OT return to practice post based within the Mental Health OT Service. I started this post in March 2022 with a two month contract. The OT team were all incredibly helpful and supportive welcoming me to the team and making me feel very welcome, sharing their knowledge freely. I was very lucky to have the opportunity to work towards return to practice in a split post, three days in the community and 2 days in Midpark; this allowed me the maximum experience of both acute and stable mental health diagnoses and the vital role of OT in the person’s journey to recovery.

In April 2022 I completed my HCPC return to practice application and it was accepted, I am officially back on the Register as a State Registered Occupation Therapist. On 1st June 2022 I successfully interviewed for Band 5 Community Mental Health Occupational Therapy post covering Wigtownshire, and then on 21st June I was successful in my application for Dumfries and Galloway’s first Perinatal Mental Health OT post at Band 6 for one day a week, covering all of the region a region wide post and joining a small enthusiastic Perinatal Mental Health Team.

To be honest I do feel like pinching myself at times to make sure this is real, I cannot believe what a turnaround I have had in just 14 months. It has been the hardest 14 months of my professional life and the most rewarding; I cannot wait to see what the future holds for me and my career as an Occupational Therapist. If I can do it, so can you. There has never been a more exciting time to be an Occupational Therapist with many development’s in service delivery from Vocational Rehabilitation, First Episode Psychosis Teams and Perinatal Teams to name a few.

If this is something you are considering doing it is definitely worthwhile linking with your local NHS AHP Practice Education Lead for support and advice regarding organising clinical practise experience. RCOT website is also helpful and HCPC. For private study I found TURAS and NES Scotland very helpful with a broad range of modules and resources to access. Also depending on the area of work you wish to return to it is worth reading over latest government policies and strategies that are readily available.

Special thanks must go to my amazing family Kenny, Euan, Eilidh, Beth, Mack, Finn and Bert. My old university friend Lesley Bodin (NHS Lanarkshire) for all the support and reading material. Finally all my new colleagues in Dumfries and Galloway Mental Health OT team, but especially Jacqui Pike, Claire Martin, Sue Linford, Michelle Weems, Christine Bark, Nikki Sacuta and Inna Tjurina without their support and belief that my return to practice was worthwhile I would not be back doing the job I love. THANK YOU.

Black History Month

To mark Black History Month, we share stories and reflections from two members of the Dumfries & Galloway Health & Social Care Partnership. Alwayn Leacock, Clinical Teaching Fellow in Obstetrics & Gynaecology shares ‘From Chattels to DGRI’.  Mustapha Mubaraq, GP Speciality Trainee shares ‘The Journey of a Thousand Miles’.

FROM CHATTELS TO DGRI

Alwayn Leacock

I am a West Indian born in Montrose on the Caribbean Island of St.Vincent and the Grenadines, which lies 118 miles West of Barbados and is roughly the same size of 150 square miles. It is inhabited by a mixed population of one hundred and ten (110) thousand people largely of slave descent 66%, Mixed 19%, East Indian 6%, Caucasian 4%, Other 3%. Sadly, the original indigenous population Caribs or Kalinago constitute only 4%. It is an Archipelago of Islands and Cays running South on a volcanic ledge from mainland St. Vincent in the North, extending Southward giving rise to the Grenadines, until one encounters Grenada. The Grenadines are so called because they, along with Grenada, were French territories but were ceded to the British in the treaty of Paris 1763 when Grenada became British for the final time. This mountainous Island is divided into Windward and Leeward sides by a central spine of mountains with an active volcano, La Soufriere, at the Northern point. Nestled at the feet of the La Soufriere volcano on the Windward side are the villages of the indigenous Kalinago peoples, Overland, Sandy Bay, Owia and Fancy with some of the most fertile volcanic ash enriched arable lands. La Soufriere erupted in 1902, 1979, and in March 2021. These volcanic eruptions are responsible for the unprecedented fertility of the soils of St. Vincent and to an extent the soils in Southern St. Lucia to the North and Barbados to the East.

SLAVERY

Mention slavery and everyone who is not African or of African descent becomes uncomfortable. Mention the Jewish holocaust and everyone is repulsed by the barbaric and inhumane way in which six million Jews were sent to their deaths in six short years by the Nazis. Started by the Portuguese and emulated by other European powers, slavery took place over four hundred years with the loss of life of millions. Britannia ruled the waves and commandeered the lion’s share of the slave market.   About 1.8 million slaves are reputed to have died at sea and never got to the Caribbean. Over 12 million people were brought to the Caribbean and the Americas to be enslaved, but only six percent 6% went to North America, namely the USA.

For 82 days sailing between Africa and the Caribbean (the middle passage) slaves were shackled ankle to ankle and were merely tossed overboard to a watery grave if they died at sea. Slaves were also tossed overboard alive to lighten the load to prevent ships from floundering or sinking in high seas or hurricanes.  There was no financial loss to the slaves owners because slaves were heavily insured property and their owners were well compensated, probably benefitted from their loss. There are historical accounts of one ship, the “Zong”, when slaves were deliberately tossed overboard to perpetrate insurance fraud.    

ANCESTRY

I cannot deny my ancestry any more than anyone in Scotland could deny Robert the Bruce, Bonny Prince Charlie or Rabbie Burns, a much feared tax enforcer and collector who once contemplated the six week voyage to the colonies to seek his fortune. Scotland has a unique role in slavery because Scotsmen were mostly the middle managers who managed the estates for the absentee English Landlords. Some were of course Landlords/slave owners in their own right. Many of them sired many children with African slaves. It is because of this practice for over five centuries that the heritage and lives of Scots, Welsh, Irish and Englishmen are intimately, intricately and inextricably linked. European genes and diseases have been infused and woven into the fabric and life of the peoples of the Caribbean. Yet we arrive at the designation of West Indians like me as “Afrocaribbean” which totally denies that hefty European influence on religion, culture, habits, and genetics into the peoples of the Caribbean.  This vexed question of how Europeans were present yet “not at fault” remains at the heart of a dire need for reconciliation and reparations.   How do we also arrive at the very offensive term of “mixed race” when we had no choice but to be mixed by this legal system of enforced insemination that would be frowned upon today as rape and  historical sex abuse with consequent legal prosecutions?

There is no Caribbean country that has not been colonised by a European country (Portugal, France, Spain, Britain namely England and the Netherlands.  I was born a British subject but that ended when in 1979, 43 years ago my country was granted independence. However, my white colleague, with whom I grew up, retained their British citizenship because all through the period of slavery, British law stipulated that white persons born in the Caribbean are British.  Today those white descendents, on coming of age, apply for a British passport and move to Britain to live with cousins, be further educated and work with all the rights and privileges accorded a British citizen. A lack of understanding of this process led to the “Windrush” scandal and latterly a statement steeped in ignorance by the current foreign Secretary himself, a man of mixed parentage, that the people from the Caribbean are “foreigners”. These “foreigners” rallied behind the crown and empire to fight two world wars, raised funds to purchase aircrafts for the Royal Air Force and  sent their  pots, pans and garden  railings to be melted down for the war effort. The minority white West Indians, aka “planter class”, retain the privilege of owning the best arable lands on the islands and control the economic wealth of the islands. When slavery ended the ex slaves were forced to take to the hills to live and built their wooden and wattle and daub houses there. During slavery, slaves were given plots of land to cultivate to provide subsistence for their families. They were of the ill conceived notion that the land belonged to them only to be rudely informed otherwise, when they abandoned the plantations at the end of slavery.

INDEPENDENCE

The social disparity between the lives of the colonies and those in Britain led to the call for independence because for example, whereas a school would be built in Britain with all the amenities required, a comparable school in the Caribbean would be built with galvanised roofs and non tiled porous concrete floors that cannot be easily kept clean. Learning was impossible indoors in the 28 degree heat and many afternoon classes took place outside under the shade of the trees. The non Caucasian Caribbean folk pay four times as much to be educated in Britain whilst earning one quarter of what the average British citizen earns. Take for example the cost of our new DGRI built at the cost of 200 million pounds. This amounts to the entire budget of the state of St.Vincent and the Grenadines. There is no such thing as benefits in the Caribbean. Welfare for the elderly and care in the latter years comes through having large families.

We cannot forget our ancestry because we were denied education for over four hundred years. To be caught reading or educating oneself was punishable by the whip, amputations of fingers and hands, the stocks, imprisonment and hanging. The only method of keeping our history was for the ancestors to pass it down to the generations in stories and folk song as my late grandmother did.  She is the only grandparent I knew. She was born in 1911 and remembers being told stories by her grandmother who was a slave. She would pass those stories about the cruelty of slavery to her children and us her grandchildren at every opportunity. Slaves were not thought to have a soul hence their bodies were not laid to rest in consecrated earth in Churchyards or Cemeteries. To this end not many people know where their ancestors are buried on the island. If they were buried, then it was in a reserved part of the burial ground, certainly without a headstone and definitely not amongst the white folk. Alternatively they were buried in their own slave burial ground. This practice was however discontinued at emancipation in 1838. It is important to note that Catholics initially got this treatment too. Irish Catholics enjoyed a free status just above that of the slave.

When I arrived in Britain on January sixth 1986 as a medical student; I walked into the education centre where the secretary of blessed memory Eve Titshall expressed surprise as she was expecting someone white from Wales. I knew that my surname came from Yorkshire but was surprised to find out that Alwayn was a Welsh forename carried by both genders, albeit spelt differently. She was an ardent socialist who literally adopted me there and then. From that day onwards until I returned home, there was never a day she didn’t enquire how I was doing and getting on and if I needed anything. She would even lend me her old Morris Minor so that I could get to my psychiatry clinics and tutorials at St. Ann’s Hospital in Haringey London. It was at this juncture that I first realised that there was such a thing as “mixed race”, “Afro Caribbean” and “miscegenation”. These words offend the very soul of every West Indian born in an English colony. Slaves were often referred to as monkeys by the enslavers and colonisers, so that today, being called a monkey is also very offensive and derogatory.  Black immigrants to the U.K. were widely rumoured to have tails. My relatives recall going to parties in London and being felt from neck to bottom when in intimate hold with white women.  When they enquired from the women why they did this, the answer came that they were feeling for their tails. I still cringe today when patients refer to their unborn babies or toddlers as “cheeky monkeys”.

RACE

Growing up we were used to several shades of blackness/whiteness but never had a preoccupation or reason to remind ourselves who was what. We befriended who we liked, fell in love and married who we loved. The dividing line was always rich versus poor, not skin colour. The Colonisers used skin colour to segregate slaves and came up with a gradation of whiteness ranging from Mulattoo½, Quadroons ¼, Mustee ⅛ and Mustifino 97% white. All of the preceding terms are considered highly offensive today. Growing up on the island we were one race, irrespective of shade of skin, and readily identified with Africa as our ancestral home. My extended family is a well brewed cosmopolitan mixture of Caribs, Portuguese, English, Hispanic, Japanese and East Indians.

We also felt proud to be British but our European/British ancestry has never been acknowledged. When applying for jobs or further education we never had to identify our race and still don’t.   “Truth be told” our race has been mixed from day one. Black women were the bulwark of slavery; they provided free labour and pleasure and weewere property. Despite being married and living in a family setting, they could not deny being available for the pleasures of the white overseer or master and their husbands could do nothing about it.  Slavery was predicated on profit only, so that whilst the white men pleasured themselves with the female slaves who they often portrayed as being promiscuous, they did not want the added financial burden of bringing up children who were not allowed to work in the fields until age ten.  

Black wombs gave rise to slaves, whereas white wombs, on occasion, gave rise to freedom for children sired by black men.  The prevailing practice was that when paternity was uncertain/questionable, it was left to be confirmed with dire consequences if it turned out that birth child was of Negro blood. In many cases the umbilical cord was not tied and the baby was left to exanguinate and announced to the unsuspecting public as a still birth. The offending suspect black male slave who would have been mercilessly beaten in public, sent to the stocks or executed would receive a second punishment if they survived the first.  He however had no power to refuse the advances of the white mistress and was often beaten for refusal. Marriage of slaves was not legal, sanctioned or encouraged. Slaves married in secrecy within their own environment.  Many families were broken up by wives, husbands or children being sold and sent to different Islands.    The “mixed” children, who did not suffer this fate, were brought up free in the plantation houses; wet nursed by the house slave and were given less menial tasks.   

Visitors to Scone Palace the seat of the Murray Dynasty in Perthshire where many Scottish Kings were crowned will see portraits of such an example of a free black woman.  Dido was the niece of Lord Mansfield who possessed a double peerage. He was solicitor general before becoming Attorney general to the King. Dido was brought to Perthshire by her uncle to live upon the death of her father a senior naval rating and the nephew of Lord Mansfield. Dido’s mother was a black slave. White guests were astonished that a black woman sat at the same table as the white aristocracy to be served meals and very much equitably treated at the after dinner events.  Dido later moved to London to be the private secretary of Lord Mansfield the distinguished jurist who did much to enhance English merchant law on the eve of the seven years war that underpinned British Naval dominance of the high seas to the advantage of the slave traders.  However, he avoided issues of slavery; his main and only contribution being to rule that an escaped slave, James Somersette, who escaped slavery in Virginia, and moved to a free country such as Britain could not be returned to the colonies to be re-enslaved or punished.    Interestingly it was the British Navy that enforced the end of trafficking of slaves from Africa to the West Indies.

The absence/scarcity of white females during the early part of slavery meant that black enslaved women satisfied the sexual needs of the white male enslavers by default. They were property and the practice continued for all of the period. Despite that proverbial denial we West Indians are therefore NOT AfroCaribbean but AfroWelsh, AfroIrish, AfroScot, AfroHispanic, AfroEnglish, AfroPortoguese, AfroFrench, AfroDutch.  

ECONOMICS:

Slavery was steeped in commerce and profit making; it was not uncommon for a slave to work to buy his freedom and that of his family and then be allowed to have slaves him or herself. It was only through this cheap labour that they profited. Despite the enforced impregnation and portrayal of black women as being promiscuous, they disdained costly child rearing which had to be undertaken for fifteen years.  It was much more profitable to import slaves from Africa.   That being said, without any family planning and contraception, it was not uncommon that a woman was always pregnant giving birth in excess of 12 children or being pregnant in excess of twenty times. Slavery presented an occasion where a mother, daughter and granddaughter may all have the same white father.

A young female,  probably out playing or foraging one day, would find herself being surrounded by white men carrying guns (fire sticks) After capture they  would be  frog marched to the gold coast and corralled whilst awaiting  transport to the colonies. They would never see their homeland again. This was an 82 day journey with humans packed as sardines, shackled heel to heel in a prone position below deck.   They were smeared by an admixture of body fluids, effluent excrement, vomitus, and menstrual blood. When the stench became unbearable buckets of sea water was used to wash the slaves down; no doubt washing diseases into bruises and pressure sores on the bodies of the slaves. Fear of mutiny prevented unshackling of the slaves for sanitary purposes so that they arrived in the Caribbean malnourished, lice infested, and disease infected.

WOMEN’S PLIGHT: (No Obstetrics or Gynaecology)

 A Girl arriving in preadolescent state would be fattened for auction and shortly after  found  herself forever pregnant, iron deficient, malnourished and having to breast feed her babies. There was provision for an annual suit of clothing/dress.  Not only did women work in the fields outnumbering the men they worked from five (5) am to seven (7) pm until the day of delivery. Pregnancy was no reason for escaping the whip and pregnant women were beaten for being lazy even when it was obvious that they had gone into labour and could not work.

There was no hospital; birth was in a crude chattel or makeshift hospital with earthen floors, often located near the stables. Delivery was by traditional birth attendees and not doctors.  The slave woman was expected to report for work the day after delivery. Those privileged to work in the plantation house:  “house slaves”, mostly females, were expected to wet-nurse the children of the white planters in preference of their own children. Life expectancy was short averaging around age (35) thirty five years, having given birth to an excess of ten children and being a grandparent by then. We can extrapolate from this that menstrual problems and endometriosis would not have existed. Complaints were mainly due to diarrhoeal diseases, fibroids, sepsis, infectious diseases and sexually transmitted diseases. Cervical diseases would have been very prevalent with no surgical cure or worthwhile medical intervention.   In many cases frank quackery and experimentation prevailed. Women affected by cervical cancers and the complications of birth such as rectovaginal and vesicovaginal fistulae would be shunned and placed in isolation. Womb cancer was rare but infant mortality was very high, partly for reasons of infanticide explained before. However, slaves also committed infanticide to try and control births and having to bring up so many children. Also in cases of egregious rape and incest, but this was punishable by hanging. There were no consequences for white women who committed infanticide because their attendants were often house slaves who could not bear witness against their white masters.    

HAIROUNA

St Vincent and the Grenadines prides itself with being the last country to be colonised by the British as we had fierce indigenous ancestors the Kalinago who fought off the French 1719 and British 1723. The French had been trying since 1610 to settle the island.   The Island became a haven for runaway slaves from other Islands (Maroons). Two British ships carrying slaves sank off St.Vincent  between 1664 and 1665. Some  slaves swam to safety and others were rescued by the Caribs. They were  enslaved and intermarried and gave rise to the Black Caribs or Garifuna. The Garifuna were so fierce that even after the seven years war 1763 when the Island was ceded by the French to the British by the treaty of Paris; the British had difficulty settling the island.

The British fortified each island with a series of forts with cannons placed 1200 feet apart. The cannons had a range of 600 feet so that any invading French ship by sea would always be caught within range.  However, the black Caribs of St Vincent were so fierce that a fortress was built between 1763 and 1806. It was named Fort Charlotte in honour of Queen Charlotte the wife of George III,   herself of Moorish ancestry. It perched on Berkshire hills with Edinboro village (Edinburgh) nestled at its feet and overlooking Port Kingstown. Uniquely the cannons of this fort face inland to defend it from the Caribs. At the sign of trouble the Governor whose mansion sits at the top of the Botanic gardens would be driven to the fort a mile away to safety and the draw bridge retracted.

For the short duration in which it became fully established as a slave colony, St Vincent produced more  sugar than  all of the Caribbean  Islands save for Cuba and Jamaica. The only surviving medical documentation of the care of slaves comes from the Island recorded by the colonial doctor, Dr. Collins, an owner of a plantation and slaves. His medical manual, written in 1803 (Practical treatment for the management and medical treatment of Negro Slaves) forms part of the archives of Kings College London and the Home Office. This manual detail all the apothecaries measurements and how to make up medicines for the treatment for every ailment that affected slaves. At a time when there were fierce arguments in London for the abolition of slavery, he argued against abolition and for better treatment of slaves. The rationale was that if slaves enjoyed better wellbeing, more value would be gained from their longevity and ability to work.  He records that “the blood of Negros is of uncommonly dilute texture, possessing in numerous cases scarcely colour enough to tinge linen”  In hindsight, and knowing what we do today, it is most likely that slaves would have been proverbially anaemic, iron deficient and nutritionally deprived, plus carriers of sickle cell disease.

HISTORICAL PECULIARITIES

Nutrition and food supply was such a heavy burden to the planters that the breadfruit was brought to St. Vincent and the Grenadines on January 23rd 1793 by Captain James Bligh, of Mutiny on the Bounty fame, from Tahiti. The first sapling was brought on HMS providence and planted in the Botanic garden to be propagated before distribution to the other islands. This Botanic garden is the oldest in the Western hemisphere and was established by a Scotsman, George Young, a surgeon in the 48th Regiment of Foot. He was a graduate of Glasgow University; he matriculated in 1754 and gained his license to practice in 1764 having served through that time in many military campaigns in North America.  Young was a keen Botanist and has written extensively about life on the Island. The garden was created on the orders of the Governor, Robert Melville, in 1765 so that plants could be propagated for the procurement of medicines for the British Army and Navy; Britain having just won St. Vincent from the French, but there was little Government funding for the garden. So important was the garden that even when Young had to relocate to St. Lucia as the French had taken control of the Island, he was still consulted by the French curator about the well being and care of the plants.  When the garden came under threat by the resident Governor who occupied the estate and almost ruined the garden, orders were sent out from London rebuking the Governor and making the garden a protectorate. The second curator was also a Scotsman, Alexander Anderson from Aberdeen, a graduate of St. Andrews University who was the assistant surgeon to George Young. Today the Botanic is the location for the Nichols wild life conservatory for the preservation of the Amazona guildingi Parrot that is native only to the Island. The Island also has the second oldest forest reserve in the western hemisphere: situated in the parish of St. George 14 kilometres from Kingstown it is a natural habitat for the parrot.

WHALING & BOAT BUILDING

The twelve 12 square mile island of Bequia 9 miles to the south of mainland St. Vincent is unique. It was the holiday Island retreat of Prime Minister Anthony Eden, who bequeathed funds to have a park created in his name. It also has a Whaling history. Traditional Whalers are allowed, under International Whaling convention, to slaughter one Whale annually for local consumption and subsistence.  These whales come to the Caribbean waters to give birth in the sheltered Bequia sound. There they are harpooned by local  harpooners, descendents of the Scots; Vis a Vis the Ollivieres and Mitchells.  Whaling was brought to these parts by Scottish Whalers who chased the whales across the Atlantic to Bequia and from North America. Once caught, the whale’s carcass is taken to the only remaining of the two whaling stations on “Isle de Quatre”, a tiny off shore cay in the sound.  The whale’s blubber and sperm containing putrecene and spermidine were exported back to Britain and North America to fill the oil lamps of the houses and the streets lamps and to make perfumes for the great and the good. Pilot whales are also caught on the mainland in the town of Barouallie for local consumption (black fish).

Bequia is also famous for boat building and was once deemed the boat building capital of the Caribbean. Many boats  which plied the Caribbean seas were built in Bequia up to the mid seventies when the craft ceased at the death of the last shipwrights.  I remember plying the Bequia channel reputedly one of the deepest sea water channels in the world on these locally built boats, “Whistler” and “Sea Hawk”, on day trips to Bequia or to spend my summer holidays. Today boat building is limited to small fishing and Whaling boats and model boat building.   These craftsmen William Mitchell and his three sons were mainly Scottish descent. The industry was pioneered by an Englishman Mr. Benjamin George Compton; Mitchell’s father in Law.  

THE RICH AND FAMOUS

The Island of Mustique lies within the archipelagic jurisdiction of St. Vincent and the Grenadines. The Grenadines are so called because they were originally Grenadian territories under French rule but were ceded to the British after the seven years war. Most people are aware  of Mustique as the haunt of the rich and famous, including the Royals.  The island of 1400 acres was bought for 45 thousand pounds in 1958 by Colin Tennant, the third Lord Glenconner. His  family seat is in Inverleithen on the 9000 acre estate surrounding a castle in Peeblesshire. He was earmarked by Queen Elizabeth, the Queen’s mother, to be a suitor for Princes Margaret; but she fostered nothing but a strong platonic relationship with him. He granted her a parcel of land on Mustique where she built a house to seek refuge away from the press and paparazzi; or so she thought. Mustique is the home today of celebrities such as Tommy Hilfiger, Shania Twain, Mick Jagger and Brian Adams. When he sold Mustique, Lord Glenconner moved to Soufriere in St. Lucia and settled in his chalet at the foothills of the Pitons establishing another exclusive tourist resort there.   He willed his estate of 22 million pounds to his illiterate elephant carer Kent Adonal, who cared for him at the end of his life when he lay dying from cancer. The will was contested by his wife of 54 years in Peeblesshire.

ROLE OF THE CHURCH

Religion was used to subjugate slaves. The church itself owned many slaves. Dr Collins, in his manual, speaks to the bible ordaining slaves to be subservient and obedient to their master. St. George’s Anglican Cathedral in the centre of Kingstown possesses a gilded wooden chandelier gifted to the church by George I and a stained glass window gifted by Queen Victoria who was horrified at St. Peter’s red coat. Underneath the Chandelier lies the stone slab epitaph and burial site of Scotsman Major Alexander Leith from Aberdeen.  Leith came from a prominent family in Aberdeen but his family lost their inheritance by internal squabbling. Leith, a trained attorney, travelled to the colonies in 1771 to seek his fortune. He was commissioned into the local militia as a captain. The militias’ main role was enforcing the laws of slavery and defending the island from the French. But along with his cohort of Scottish friends; Murray Farquarhason of Coldrach, McDuff Fyfe from Cabrach, William Lumsden of Cushnie, the ulterior motive was to acquire more Carib lands for expansion of plantation slavery and sugar production. He owned ten slaves and had two sons by an enslaved woman. He is memorialised and venerated by Walter Scott in his famous poem “Hiroona” for having killed the Carib Chief Joseph Chatoyer in the second/last Carib war at Dorsetshire Hill overlooking Kingstown where an obelisk now stands in Chatoyers’ memory as the first national hero. Chatoyer’s body has never been found. Leith however was buried in the Cathedral with great military pomp. Upon his death his two sons and wife were granted freedom “manumission”. The proceeds of his estate were use to educate one of his sons in Aberdeen who later returned to the island and along with his mother and brother, bought and owned slaves.

FATE OF THE CARIBS

Shortly after the last Carib wars in 1796, the British rounded up the Caribs and detained them offshore on a barren islet called Balliceaux. During that time as many as 5000 Caribs were thought to have died and perished from exposure without clothing and lack of rations. From Balliceaux they were transported to Roatan an Island 35 miles off Belize and Honduras.  Balliceaux is today revered as a shrine to their ancestors. Garifuna the world over look to St. Vincent and the Grenadines as their ancestral home. The Garifuna language and culture thrives in Honduras and parts of Belize but has been lost to the indigenous Caribs of Saint Vincent and the Grenadines.

COLONIAL GOVERNANCE

Many of the  colonial Governors  of St. Vincent and the Grenadines were Scottish. Some of their epitaphs can be located in St.George’s Cathedral. Governors: Dundas, Murray, Brisbane, Bentinck, Dalrymple, Cameron, Campbell, Coutts, Musgrave, Rennie, and Wright to name a few. Indeed many of the black descendents can trace their ancestry back to Scotland. The relationship between England and the Union States (Great Britain) were such that the tendency was for the English landlords to remain in Britain and travel out to the colonies on occasion (absentee ownership), whereas the Welsh, Irish and Scots were the managers who lived in the islands, ran the slave estates and enforced slavery. The Welsh, Scots and Irish were also land and slave owners in their own right. There seem to be no enthusiasm for the Caribbean people to reconcile their Scottish ancestry partly because there is persistent denial of the facts of history. In 2014 the SNP under Alex Salmond invited Scots the world over to come home to Scotland. He mentioned every continent in the world and all of the Diaspora, but not a single Caribbean country.  

SELF GOVERNANCE

We arrived at a state where on the island growing up; as a colony intra regional travel was unrestrained, because we were all British. After a failed attempt to federate in 1958 -1962; Jamaica was the first to withdraw. This prompted Eric Williams, leader of oil rich, Trinidad to usher his proclamation (one from ten equals Nought.) We then emerged as separate states as Vincentians, Barbadians, Jamaicans, Trinidadians, and Antiguans. Before this we  moved freely from Island to Island to work in the  civil service, West India Regiment or to find better lives. Today as independent countries, a passport is required for intraregional travel. Independence has brought us self governance. Britain’s aim was that we would emulate the Westminster democracy but far from; we are now far too small unsustainable states, more dependent on international aid than before. Some of our governments are democratic tyrannies where there is direct victimisation of citizens who share different political opinions. Had we been give equal status in a union of British states with Britain or turned over to the USA as payments for debts owed during the war as Churchill had intended we would be better off as a people.  Time was when the children of the slaves emerging out of poverty were required to work at the large estate houses and could only enter those premises from the servants’ entrance at the back of the houses. Children visiting their white friends or accompanying any adult who worked in these houses could only do so through the back yard and remain in the kitchens. Until the late 1980s box pews were reserved for slaves and ex slaves at the back of the Cathedral; they were replaced during the refurbishing of the Cathedral by the first black Dean of the Cathedral, Reverend Ulric Smith. One pew was retained for historical interest. Emerging out of this reverence is a culture unique to St. Vincent called “nine mornings”. The novena was well attended at 5am by the Planters. They woke at two, 2:AM  in the morning to take the trek to the Cathedral. The slaves on whom they imposed Christianity accompanied the planters for security purposes. Rather than sit at the back of the church during the service in the box pews, the slaves took to the streets in revelry and dancing for nine consecutive mornings except Sundays. They returned the church at the end of mass at seven 7:AM to accompany the planters to market for fresh foods and meats before returning home.  This unique celebration continues today in a modified form of church vigils and processions, stage performances,    street games tennis, volleyball, football, and cricket. Early morning swims, bicycle racing, bicycle decorating, skating   dance hall fetes and street jump up accompanied by steel pans ending shortly after dawn to allow for the daily traffic and commerce. Every town and village has their own ceremony.   

DEATH & TAXES

At death, taxes (death dues) were levied on the property of the ex slave and his descendents. Slaves were not compensated at the end of slavery so any wealth or property that was accrued came by hard labour and thrift and anything that was passed down by inheritance.  However, this burden was so overwhelming that very often family property had to be sold or forfeited to the state because the inheritors were unable to pay the death taxes. Life expectancy was short so that if the person who inherited died soon after, then another set of death dues were levied on that estate. Surviving family either forfeited the inheritance to the state or took out hefty loans on the property to avoid forfeiture.  In short, black people were being returned to a state of economic enslavement. Our post colonial elected Governments recognised this death debt trap and upon attaining independence Governments have abolished death dues.

THE ROYAL NAVY     

When slave trading was outlawed in Britain, it was the British Navy; hitherto they had safeguarded the slave ships at sea and were on standby to put down rebellion. Now it was they who enforced the law on the seas in order to end the trafficking of slaves and ensure that any such slaves were brought to port and set free.  The law to abolish slavery was passed in 1807 but was never promulgated until 1837 and came into enforcement on August 1st 1837. During slavery, the slaves were allowed to use lands for growing ground provisions. They abandoned the plantations at abolition and suddenly found that the lands they thought were theirs had to be vacated. They found themselves landless and took to the hills to dwell. They built their own wooden chattels some of wattle and daub.  This mass exodus of free labour saw the planters turning to India to fill the void, with the importation of East Indians from the subcontinent to work as indentured labourers.

Whereas slaves were never paid or compensated, the Indians were paid for their labour. Indians who did not repatriate to India were then able to get an economic foothold on the islands and soon built their own homes and established businesses. When King George III signed the abolition of slavery act in 1807, the planters and slave owners demanded compensation for lost of property. This compensation was financed by a loan from Nathan Mayer Rothschild and his Brother-in-law Moses Montefiore in 1837   to the value of 15 million pounds the total cost of compensation was 20 million. This amount (20bn) twenty billion in today’s money was finally paid off in 2015. The act came into being on August 28th 1833 and  took effect August first 1834.  August first is today celebrated in all the islands as Emancipation Day, but in the U.K. August bank is the last Monday in August.

POST EMANCIPATION STRUGGLES

How do the descendent of slaves who were never educated, one suit of clothing annually and no property arrive at where we are today? It all boils down to the matriarch of the family my grandmother. She fell pregnant at age 13 and lived in a chattel house at the top of Monkey Hill, now aptly renamed upper New Montrose because of objections to the name by the residents.   Her outside kitchen was made of wattle and daub. The oven was outside of the kitchen and made from an oil drum. Coals made from the trees in the surrounding woodlands were placed on the top. The fire place was made of three rounded stones upon which the cast iron pots stood. The smoky taste of my grandmothers’ food is irreplaceable.  One of the ironies of life is that with increasing wealth of the descendents of slaves there has been an urge to build large mansions of the hill sides. This is merely to show wealth and in pursuit of a view thereby crowding out the original poor settlers who occupied the hill sides.  

With only primary schooling and no skill my Grandmother and many of my great aunts were house servants. She being a woman relatively uneducated and unskilled, fell pregnant at age 13. To her, education was the key, with the help of my father the oldest child who left primary school at age twelve (12) and worked to help his mother to care for his eight (8) younger siblings, using small subsistence farming thus enabling my third uncle to become a police. He rose to the rank of assistant commissioner of police on the island after being trained at the regional police centre at Seawell in Barbados then at Hendon in London. My last uncle was able to attend University and become a Secondary School Principal. Upon her death Grandmother a staunch Anglican, who got up at five  (5) am every Sunday to attend mass at six 6 am and was never late; was buried in the Church yard, as was my late mother three years ago. She too awoke at 5 am to attend mass and was never late. My mum another strong believer in Education; a tummy upset was easily cured with a dose of castor oil and off to school.  Our route to success was education which my father insisted on. All of his children attended secondary school. He being a self made entrepreneur worked to pay the school fees for his children to attend the best primary and secondary school in the state. He went to night school to learn math so that he could assist my older siblings with home work, and paid for private tuition. 

By the time I came along school fees were abolished but books had to be bought.  However, I was fortunate to be granted a government scholarship to the premier secondary school where books were provided. Thereafter I gained another scholarship to Medical School after working for six months as a secondary school teacher and three years with Barclays Bank. Working in Barclays Bank was a momentous achievement and milestone because hitherto only the children of the planter class would be employed in a Bank, let alone Barclays.  Born in Montrose, Kingstown, St Vincent, I spent the last 23 years in the UK. 22 years in spent in Scotland, 18 of those in Dumfries and Galloway. Of those 18 years fourteen spent as the Clinical Teaching Fellow.  Prior to this I had returned to the island and spent 10 years in service.  One of the strangest paradox is that having been schooled in English all my life and speaking no other language than “the Queen’s English” which our parents insisted on (no jargon or local pigeon in their presence). I was required to take an English test (IELTS) before returning to Britain to work. I had to travel to Venezuela where only Spanish was spoken to take this exam. When Britain opened up to the EU I was displaced from my job and became unemployable because I was not an European citizen. Many people from Europe walked into the English speaking NHS in preference to English speaking “Afro Caribbean” former colonists, not being able to speak a word of English. The results of such a bold decision are well known with untold tragic death due to poor communications.    

I am often greeted by the question “what brought you here”? My standard answer is opportunity and education. The fallacy that we all want to migrate to the U.K. does not stand. This is exemplified by the citizens of Puerto Rico and Hawaii who do not all rush to live in the U.S. or citizens of the French colonies in the Caribbean who know that they could always go to France for a weekend and return home to the Caribbean where they prefer to live within five minutes of a Malibu and the Beaches.

Given the fact that I cannot separate myself from my signature woolly hat come rain or sunshine at any time of the year attests to this. One would realise the herculean effort it takes to abandon the climate and the beaches of the Caribbean for the weather of the U.K. and Bonny Scotland.    

Reference: Slavery Images: A Visual Record of the African Slave Trade and Slave Life in the Early African Diaspora

THE JOURNEY OF A THOUSAND MILES

Mustapha Mubaraq

My love for medicine began when I was 8 years old. I remember my mama asking me what I want to become in life. The only thing that came to my mind was treating people – I told her I would love to be a lifesaver. Since then, I have been committed to this journey. I remembered how I had started watching documentaries (medical) on our 10-inch black and white TV as a little boy. I saw a documentary on Clarence Walton Lillehei (1918 – 1999), who may justifiably be called the “father of open-heart surgery”. I was hooked by what I saw, and the dream of practising medicine has never left since then.

The first litmus test was securing a placement in a science class during junior to senior secondary school transition (high school equivalent here). It was a hard-fought victory, as I was among the few who eventually made it. There were many ups and downs, but I passed my high school exams with flying colours. In Nigeria, being a doctor is a big achievement. For instance, there was no single doctor in the entire local community I came from. Some of my mates accepted defeat before the battle started. They thought medicine was only for the gifted ones. Even though my juvenile mind had no idea how it would happen, one thing was clear: “nothing else but medicine.”

I studied hard during my A-level days. The system was designed so candidates can only apply to a limited number of medical schools (maximum of two). I chose the two most highly rated colleges of medicine. I got my first choice even though only about a hundred of us were selected from over nine thousand applicants across the federation. Medical school was hard – admission into medical school does not mean you will be a doctor. Only about half of the new intakes do make it to the final. There were many hurdles, but I never lost focus. I was determined to see it through.

In my second year, the proper training began. The challenge was things were too theoretical than practical. I had to commit a lot to memories, and I found them vague and boring. I then began to research medicine abroad. Facebook was trendy then, and I managed to follow some USMLE groups and read people’s “matching” stories. That inspired me a lot and re-shaped my thought about medicine. I started using USMLE-styled materials to study, and I loved them.

To cut a long story short, I graduated 6 years and some months after starting medical school with loads of achievements – always an honour to have piloted the affairs of my set “quiz and debate team” with resounding success. Immediately after graduation, I wrote the first USMLE step and did amazingly well. I had wanted to have a go at the second, but the situation in my country took a negative turn – rising inflation and economic recession made the journey daunting. Two years after writing the first step, my financial standing remained poor, making me retrace my steps and find another alternative.

THE UK JOURNEY

After it dawned on me that I might not be able to finance the US journey, I had to think of possible alternatives. I was left with two options – to remain in Nigeria and go into specialist training or try PLAB (UK equivalent of USMLE) and move to the UK. I remembered waking up several nights trying to permutate things – I decided to give PLAB a go having considered its financial implication. I started by writing IELTS but again suffered another setback. I did not make it the first time.

My wife had written the same exam (IELTS) a few months earlier and passed on the first attempt. She was doing her pre-registration training (Pharmacy) then and was keen on leaving the country. We both sat down and decided she should apply for OSPAP (Overseas Pharmacists’ Assessment Programme) organized by the UK Pharmaceutical Council, of which IELTS is a key requirement. Again, raising money for the program was difficult, but we were determined this won’t be another failed experiment. We sold off some of our belongings, including cars and applied for loans from friends and family. It was difficult raising funds because of the country’s economic situation at that time. So, the decision was to leave my daughter and me behind so that we could concentrate the little we have on sponsoring her UK journey. That was the bravest decision we ever made as a couple!

THE PANDEMIC ——

Two months after my wife had left Nigeria, the novel virus was found somewhere in Wuhan. As most pandemic does, it sends chaos everywhere, and most countries begin closing their borders. I became very nervous and traumatized. Every day I looked at the eyes of my daughter, I could only feel sorry for myself for engineering the separation. While I was working 24 hours in Nigeria to offset the loans we incurred, my wife was doing a care job to survive the pandemic. I lost count of many nights we both cried our hearts out. We weren’t sure if our decision was right or wrong.

AND THE WIN ——

On the second attempt, I managed to scale through the hurdle of the English exam. My wife and I were so happy that day. We both agreed I would book the next available PLAB 1 slot and give it a go. Unfortunately, a few days later, GMC announced that PLAB exams were suspended till further notice. Months after months, I kept checking the GMC website and reading all PLAB-related news to see if the suspension would be lifted and new dates announced. Disappointingly, 6 months had passed with no date announced.

As things begin to ease off, the UK government begins lifting COVID restrictions. I knew the border would be open to immigrants in no time, and the flight would resume. So, I had only one task: to prepare all the necessary travel documents and apply without further delay once the announcement was made. As I predicted, things started moving fast, new PLAB exam dates were announced, the UK government lifted the travel ban and gradually, life started returning to normal – the good old days!

I passed the two licensing exams in record time! Just about two months apart. I was happy that my efforts and sacrifices paid off at last. On landing at Heathrow, my wife was already in terminal 5, waiting to be reunited with her family after 9 months of separation.

It dawns on me that as humans, whatever we have begun, we are more than capable of finishing it. We need to sometimes re-strategize and never take our eyes off the goal.