An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology

The Pneumonia in Bed 5 by Sian Finlay

Although it is sometimes easy to forget it amongst the busyness of front line clinical duties, I am a person.  I suspect many of you are too.  Occasionally I am unwell, but I consistently find that I still remain a person during this period – I have never yet become a disease!  So why is it that when patients come into our care, we so often default to calling them by their diagnosis instead of their name?  Go onto any ward and I guarantee it will not be long before you hear someone described as ‘The Chest Pain’ or ‘The Pneumonia’.  Many handovers will include phrases such as ‘He’s a UTI’.

No, he isn’t! He’s a PERSON who has a UTI!

A common (and potentially even worse) variant of this is the ‘bed number’ name, exemplified by ‘Bed 3 needs the commode!’  Sometimes attempts are made to justify this practice with the excuse that it protects confidentiality, but let’s be honest here.  The truth is that it simply demands more mental effort to remember the patient’s name and we are taking a short cut.  All very understandable in a busy environment, and I really don’t blame anyone.  You might think it is just semantics anyway – what does it matter if we call someone ‘The GI bleeder’?  Well I argue that it does matter.   More than you think.  These patients are people, no less complex and emotional and fragile than you or me.  By depersonalising them, we are subtly starting down a path which allows us to forget this; which allows us to view them as tasks in our day rather than the individuals they are.  If you are unconvinced, try this little exercise; read these 2 sentences and see if they elicit the same emotional response in you:

Bed 5 is agitated.

Tommy is agitated.

Would you agree that the second sentence immediately makes us feel more empathy and compassion towards its subject?

Many people will be aware of the late Kate Granger, the inspirational doctor who responded to her diagnosis of terminal cancer by establishing the ‘Hello, my name is..’ campaign.  Sadly Kate died last year, but her campaign lives on and has touched many of us in the healthcare profession.  But Kate’s work didn’t begin and end with wearing a smiley badge with our name on it; it is in essence about remembering the humanity of our patients and treating them as fellow human beings.  And I can only imagine Kate’s fiery reaction if she ever overheard herself being referred to as ‘Bed 5’!!

But we are all under pressure.  What if we genuinely can’t remember the patient’s name and are just trying to communicate information quickly?  Surely that doesn’t make us uncaring?  Of course it doesn’t, but in times of acute amnesia, we could at least say ‘the man with pneumonia’ rather than ‘the pneumonia’.  And that should only be a holding measure until we can remember his actual name – surely essential for safe communication anyway!

I hope I have convinced you that words do matter.  The phrases we use set the whole tone for the level of kindness and empathy we expect in our clinical areas.  So if any of this resonates with you, I hope you will lead by example.  Look at your patients and remember they have hopes and fears and histories and personalities…and almost always names!!

Sian Finlay (aka ‘The Migraine on ward 7’) Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

• every person is born with worth and dignity
• every person has the ability to choose between doing good and doing wrong
• every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway

Some Personal Reflections by Jeff Ace

When TS Eliot wrote that “April is the cruellest month…” he ruled himself out of the running for patron poet of the NHS. April’s fine; the flu season is over, Norovirus is winding down and A&E attendances / acute admissions numbers are actually beginning to resemble Chief Exec planning assumptions. No, February and March are I think the trough of the cycle in the NHS year. This is when it can seem like winter’s been going on forever and people can feel just a little drained of optimism and bounce. Everyone will be different in how they react to this drop in bounciness of course; I definitely become more irritable and see a marked change in my threshold for when swearing is the appropriate response.

 
To be frank, I’ve been feeling a bit lower than the seasonal norm recently. This has nothing to do with work but all to do with the twists and turns of modern family life. My lovely old step dad died in February after a steep dementia driven decline. He’d spent his last couple of months in a care home in Swansea and whilst staff there were great, each visit re-emphasised the unfairness of a good life ending with multiple indignities. He was a man who’d fought (and survived blast injuries) in Burma, had a career and great family life and watching his last few weeks through the sort of time lapse lens of weekend visits was hard.

 
When I got the message that he’d died, I managed to take a few days off to help my mother with the various arrangements. She somewhat disrupted this plan by falling and breaking her femur on the first morning after I’d arrived. Fair play to the Welsh Ambulance Service and Morriston Hospital in Swansea, the transport, assessment, admission and timeliness of operation were all as you would wish it to be but I began to reflect, as I was supporting my mother through this whilst trying to arrange death certificate, funeral and various pension type things, that I was getting a touch stressed.

 
A day or two later when I was trying to return to Scotland, I was marooned for hours by Storm Doris in a Crewe station where the only remaining foodstuffs seemed to be Yorkie bars. By this point in the week I could imagine no circumstances in which swearing was not the appropriate response.

 
All of this was a bit sudden and unfortunately coincidental, but I think it’s important to recognise just how many of our 4,500 staff are going through this same juggling of work and family issues and the impact it can have on their resilience, particularly at the end of a long NHS winter. Our workforce is ageing along with the wider population and we now have substantial numbers of people who’ll be routinely dealing with issues of care and support for relatives whilst continuing to work in a health and care system that’s never been busier.

 
We desperately need our people to retain their resilience and their creativity both to continue delivering safe, person centred care and because of the need to reinvent our services to meet the extreme financial and recruitment challenges we’re now experiencing. Our population is relying on us and we simply can’t let them down so we have to find ways to get through the times when optimism feels hardest.

 
So this is my personal shortlist of techniques that seem to work for me in attempts to retain some bounciness in the face of difficult odds. It was compiled in a Yorkie fuelled sugar rush in beautiful Crewe so might lack the academic rigour of other approaches. As a result, I would guess its evidence base is only somewhere between homeopathy and wearing your lucky pants on rugby international days.

 
1. Avoid political debates or press coverage of the NHS...

 
You know this makes sense. There are decent, passionate politicians and superb investigative journalists but life’s too short to wade through the nonsense to get to them. This winter I’ve heard that the problems in the NHS are down to managers (naturally), the patients using services incorrectly (!), GPs (what? I mean, really?) and health tourism (I can’t comment politely on this innumerate gibberish because my swearing threshold has been breached).
If you stumble inadvertently onto some Question Time debate on the NHS, don’t despair. Reflect instead on this recent IPSOS Mori poll on the public’s confidence in the truthfulness of various professions.

Solid, mid – table respectability for NHS Managers there.

 
2.Exercise…

 
Our Public Health colleagues are right on this one. It doesn’t seem much to matter whether it’s walking, cycling, or hitting a ball of some sort, I am a calmer, nicer bloke after exercise than before it.

 
3.Family…

 
Tricky one this, as I’ve already highlighted the stresses that come with family life. But it’s also brilliant, life-enhancing stuff and if I start skimping on my input to making it all work as well as life in a household with a teenage child can ever work, I feel lousy.

 
4.A bit of escapism…

 
Now and then I need my mind occupied by something so engrossing that it just about drives every worry out to the edges. Books or films work reasonably well here, but for me this is best achieved by immersing myself in sport watching (ideally rugby or cricket). I think we can all agree that this has been an awful year for rugby with results so freakish that I wouldn’t be surprised if certain people had burned their lucky pants. But there’s always an Ospreys game coming up, or the Lions to look forward to, or the prospect that this summer will finally see Glamorgan triumphant. And to top it all, there are impassioned arguments with your mates over essentially pointless things. Unbeatable.

It’s a short list of feel-better approaches and I’d welcome suggested additions of what works well for you. Using these was also only partly successful recently so apologies to anyone who’s experienced a slightly more distracted or grumpier me. April’s almost here and things are definitely on the up again.

Jeff Ace is the Chief Executive Officer at NHS Dumfries and Galloway

Why We Should Be Bold for Change by Luis Pombo

International Women’s Day (IWD) provides an opportunity to celebrate women, their achievements and their contribution to society.

IWD was first marked in the early 20th Century and was linked to the struggle of women (as a group) for equality on various aspects of their lives.

IWD is now an official holiday in several countries and it is marked on March 8th in lots of other countries around the globe.

Now, in the 21st Century Western World, we may tend to think of IWD as just an opportunity to celebrate women in a climate of total equality and fairness. However, this is not the case today as it was not 100 years ago; the reasons why will be addressed later on but briefly touching on gender and gender (in)equality is necessary before we move on.

Gender is definitely not sex!!

Gender has to do with roles, personality traits, expectations, attitudes, behaviours, values, relative power and influence that are assigned to people by society on the basis of their sex, which is biological and has to do with our reproductive organs, physiology and genetics in general.

Gender, therefore, is a cultural product – a set of ideas, values and beliefs – that makes us define people (including ourselves) and that shapes our interaction with them. Gender is relative to any given culture in which it is expressed; if we pay attention, we can certainly see subtle differences in the expressions of gender in different cultures. However, gender stereotyping, gender subordination and various degrees of gender oppression seem to be constants across cultures. The millions of women and girls from all backgrounds who are currently affected by various forms of Gender Based Violence around the world and the fact that female representation in Parliaments in most countries around the world is under 50% – with the exception of Rwanda (61.3%) and Bolivia (53.1%) – are examples of this phenomenon.

Another crucial aspect to bear in mind about gender is that it is ‘learned’ from very early in our lives and it becomes part of who we are; we live and perform gender every moment; we constantly play by its rules. We start acquiring our gender at a very early age through exposure to the culture and people (performing their genders) around us. For example, since birth or even before, we are given a name, clothes, and toys in line with our assigned / perceived gender, our bedrooms are decorated accordingly, etc. By the age of 3 we already know whether we are ‘a boy’ or ‘a girl’ and by the age of 7 or 8 the gender stereotype is completely fixed in our brains; then the performance of our gender becomes a 24/7 activity.
What is interesting about gender is that despite us being in contact with it and it being around us all the time , it is somehow (as a notion) invisible to us due to its perceived ‘taken-for-grantedness’ and ‘naturalness’. In this respect we could compare gender to gravity which keeps us attached to the ground 24/7 but we do not necessarily think about it once throughout our day. In other words, gender works like a force that constantly shapes our thinking, decisions and actions but we very rarely or never question its workings.

Is there a problem, then?

In theory there should be no problem with gender and gendered differences between people but the reality is that these differences are not neutral. They have been influenced by different ideals about the roles, expectations and relative power that should be assigned to men and women through thousands of years. These ideals have shaped the notions of what it means to be a man or a woman / a boy or a girl, resulting in concrete inequalities between people of different genders; some of them are now historical but some are current. For example:

• Lower social status was assigned to women in ancient Greece (c.283BC).
• It was not possible for women in the UK to inherit property and accumulate capital until the 19th Century.
• It was not possible for women in the UK to vote until the early 20th Century
• Rape in marriage was not recognised as such in Scotland until 1989 and in the rest of the UK until 1991.
• The policing of women’s bodies (virginity tests) (Egypt; 2011)
• In general, all over the world, sex is considered to be a service that can be bought.
• Currently, the majority of sex trafficking victims around the world are women and girls.
• Women’s reproductive rights are currently being interfered with in Ireland, the USA, and other countries.
• The domestic abuse law in the USA is currently being undermined through underfunding.
• There is a nipple double standard – the female nipples being considered “obscene” if shown in public (with the exception of nude beaches, perhaps) –
• Breastfeeding in public places is currently frowned upon by many people in the UK and other countries.
• Russia has recently decriminalised some forms of domestic abuse – first violent attack that does not result in victim’s hospitalisation; etc.

Looking at it from another angle, we can see how in popular culture (and culture in general) masculinity equals leadership, strength, individualism, power, logic, decisiveness and other traits that convey a notion of ‘agency’ of ‘being in charge’. Interestingly, traits that usually define femininity in popular culture like submissiveness, perceived weakness, dependability, relative lack of power convey a notion of ‘non-agency’ or ‘passivity’. “Real women” and “real men” are defined according to these (artificial) standards that reinforce the subordination of one gender to the other.

Now, with greater status and power assigned to men (as a group) securing this way their superiority and influence in society and the consequent subordination of women (as a group) – by the way exceptional individuals like the Prime Minister or Her Majesty the Queen cannot be considered in this equation – gender based violence finds the ideal conditions to flourish. Domestic abuse, rape and sexual assault, sexual harassment, stalking, sex trafficking, prostitution, pornography, forced marriage, so-called “honour” crimes, female genital mutilation, continue affecting millions of women and girls all over the world regardless of their background, cultural or otherwise.

What has been done in terms of preventing gendered violence and gender inequality in D&G?

The Dumfries and Galloway Domestic Abuse and Violence Against Women Partnership (D&GDAVAWP) has been tackling and raising awareness of all forms of gender based violence in the region since 2006; promoting the support available for victims and
bringing information to the general public to help develop greater understanding of the causes, effects and subtleties of abusive behaviour and gender based violence in general. Also the White Ribbon Campaign that provides a space for men to take action against gender based violence has been promoted locally.

Recently D&GDAVAWP and Colleagues from NHS Dumfries and Galloway Equality and Wellbeing Teams (who a year ago formed the D&G Gender Equality Steering Group) have organised two Gender Equality events the most recent one in partnership with Engender. This event involved group discussions searching for ideas for action. People suggested ideas (amongst others) like public awareness campaigns on gender stereotyping; campaigns to encourage people to be good role models; challenging media messages; introducing gender education from primary school; and creating a Gender Equality Network for Dumfries and Galloway.

What else can we do about it?

As individuals we may feel that this is too big an issue to tackle but if we act collectively changes can be achieved. We just need to have a look at recent history for inspiration and take the Suffragette Movement as an example, or perhaps more recent examples that challenged extreme gender stereotyping in visual media like No More Page 3, and take action on gender (and other) inequalities that we can identify in society.

Now more than ever before we have the capacity to communicate instantly with thousands of people via social media; we can exchange and develop new ideas, plan and take action and – if we want to – we can start changing the gender rules and the ideas, values and beliefs that inform those rules.

Change can start with a critical examination of our own thinking, attitudes and prejudices followed by joining forces with other likeminded people who think that change is necessary and possible. Other strategies can involve engaging in a dialogue with other people and examine their own attitudes, behaviours, the language they use, and discuss examples of gender stereotyping we come across daily.

This personal + collective change process will in turn produce change at a cultural level and in the longer run help bring bigger changes in society.

Change – like gravity – is another constant in the universe and in our everyday lives; we only need to acknowledge this and start envisioning the possibility of managing and shaping change…

Change is possible; it can be done…if we want to…

On International Women’s Day let’s #BeBoldForChange !
If you would like to join the D&G Gender Equality Network, please contact: domesticabuse@dumgal.gov.uk

 

 

Luis Pombo Is a Research and Information officer for the Domestic Abuse & Violence Against Women Partnership (DA&VAW) at Dumfries and Galloway Council.