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

Reflections on Imperfections (In memory of Dr Johan Leuvennink, my friend) by Fanus Dreyer

While writing I am listening to Dozi, a troubadour who sings in Afrikaans and Zulu.

On Monday I attended the memorial service for my close friend, Johan Leuvennink, consultant psychiatrist, who died so suddenly. For the last two weeks I have been thinking about the paths we’re on and why these are so imperfect…

In December 2012 I had a knee replacement, necessary due to damage from playing rugby, jumping from aeroplanes and boulder hopping in canyons and on the Cape coast. It was 14 weeks before I could go back to work and where else would a knee recover more quickly than in the heat and dust of Africa. So we went to Zambia for teaching critical care and then to South Africa to visit family. As David Ball and Pete Armstrong returned from Lusaka to Dumfries I went south, with a stopover in Johannesburg. At O.R.Tambo’s Ocean Basket I ate Cape kingklip and calamari, with a glass of Durbanville chardonnay. My waiter was Pioneer, who recognised me from a visit the previous year, when about 10 of us descended on them for a meal. He asked me in detail what I did and so on, and then said “You have the greatest job. Not only are you able to save people’s lives, but you actually teach others to do the same“. I was humbled by Pioneer’s insight and very thankful for his words at a time when I didn’t feel like going back to work.

Pioneer’s words led to some serious thinking. Why then was I dreading to go back to my NHS job after only 3 months off? Well, I always feel that way after experiencing something of the heart and soul of Africa, but this time it was worse. Some things happened around the three weeks we spent in Zambia and South Africa. I received emails about critical incidents in patient care that I could not have influenced, but I was still asked to comment. On the first day back home I was phoned about students who had complained and I was asked to respond, even though I had not met these students. Somehow there is this perception that, if we just complain enough and change systems constantly, we will one day reach perfection. NO, it ain’t gonna happen!

In Tanzania in 2009 our guide, Cyprian, described the caricatures of all the different nations that he had taken on safari. We laughed at how he described Afrikaners, Germans, French and Japanese clients. He said that the British were those who would say “thank you very much, it was the most amazing trip of my life”, but on the feedback form they will always write one thing that should be better or different. Make no mistake, I always take complaints or concerns of those who “suffer under surgeons” very seriously, but simple moaning leaves me cold. I have just bought a car and, although it is great to have a new toy, it is not perfect for my requirements. My job is not perfect, nor is anything else in my life. So what! I’m happily cruising along through this life and can only stand and stare at the miracles it brings every day, again and again. We meet people who have suffered unimaginable losses and with severe disability and sorrow, and they continue to inspire me. I think Africa accepts life’s imperfections more easily. That is why Rwanda could move on and why South Africa had a peaceful transition. You also see that in the total lack of self-consciousness in the girl with a long scar on her face, in the man wearing a woman’s blouse and in the patient with the large goitre or fungating cancer. So my job is not perfect but Pioneer is not far off, it has perfect opportunity, and for that I am forever grateful.

…I had known Johan since he was my student in Tygerberg Hospital. He stood out because he asked challenging questions. And then we met again in Dumfries and shared some good times together, usually in serious discussion. We walked a difficult road together. I still cannot believe that he is gone and the question that remains in my head is “What price do we pay for the work we do?” I know that surgeons have a high rate of untimely deaths, and am sure the same goes for psychiatrists.

fanus-1This took me back to thinking about the National Geographic picture of Dr Zbigniew Religa and his patient, taken after he did the first heart transplant in Poland in 1987, which took 23 hours. In the picture Dr Religa sits and observes his patient’s vital signs, absolutely drained but still alert for anything that could go wrong, while an exhausted assistant sleeps in the corner. Twenty five years later the patient, Tadeusz Zytkiewicz, holds the same iconic photograph of “giving everything”, but Dr Religa, his surgeon, had died in 2007. The patient had outlived the surgeon.fanus-2

…Three years ago I asked Johan if he could teach me to play the piano. I have no talent and no ear for music but wanted to learn to play one song. He took on this challenge with his usual enthusiasm. After months of patience from him and practice by me I was able to play the right hand of this one special song, and this is still all I can play…

I see trees of green, red roses too
I see them bloom for me and you
And I think to myself what a wonderful world

I see skies of blue and clouds of white
The bright blessed day, the dark sacred night
And I think to myself what a wonderful world

The colors of the rainbow so pretty in the sky
Are also on the faces of people going by
I see friends shaking hands saying how do you do
They’re really saying I love you…

I think that at the end there is only one question to answer and that is “Did you love enough?” I have no doubt that Johan could say “Yes, I did”….

Maybe perfection really lies in what we give, not in what we achieve.

 

Fanus Dreyer 

Consultant Surgeon

NHS Dumfries & Galloway. 

I am human by Dawn Renfrew

“I am human: I think nothing human alien to me”

dawn-1-terence-the-african

Terence the African

So wrote Terence the African, around 2000 years ago. He was a slave from Roman Africa, a dramatist, and an interpreter. He was quoted recently in the annual BBC Radio 4 Reith lectures, by Professor Kwame Anthony Appiah, professor of philosophy and law at New York University.

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Appiah Now

Professor Appiah’s subject, “Mistaken Identities”, is one of the most defining issues of our age. We all have multiple identities which describe who we are. These include those suggested by our gender, age, occupation, political affiliation, nationality, race etc. The possibilities are endless when you think about it: parent, child, sibling, friend, Bake-off fan, or Queen of the South fan are just a few.

In a healthcare setting, we also have many identities, including being part of our own discipline, team, ward or service. Sometimes we are ourselves patients, and some of us are managers. Any health condition, whether physical or mental, can become part of our identity.

Appiah himself embodies many complex aspects of identity. Half-British, half-Ghanaian, he was brought up in Ghana and England, and has now adopted America as his homeland. He is the grandson of the Chancellor of the Exchequer, Sir Stafford Cripps. He is a crime novelist, and a fan of Japanese haiku. In addition, he was one of the first people to take advantage of the new gay marriage laws in New York State. He is probably ideally placed to set about unpicking assumptions which we all have about the “labels” associated with identity.

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Growing up in England

Appiah discusses 4 aspects of identity over 4 lectures: creed [religion], country [nationality], colour [race] and culture [Western identity vs non-Western]. These are delivered in 4 different locations: London, Glasgow, Accra [capital of Ghana] and New York. The lectures cover the great sweep of history, and examples from a range of countries across the globe. They argue that identities are more complex and fluid, than are commonly supposed. They are more a “narrative”, than an “essence”, and do not necessarily determine who we are. Everywhere you look, you can find exceptions in identities, which challenge our commonly-held assumptions about them.

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Growing up in Ghana

Identity is important for our survival. It helps give meaning to our lives, and helps us feel, and be, part of a community. Evolutionary psychologists would argue that it has been critical to our development as a species. All identities are constructed and evolve over time, but as soon as you construct an identity, you create potentially not only an “us” [those within the group], but also an “other” [those outside it]. When there is competition for resources, things can turn nasty, and the “others” may be persecuted or scapegoated. So it is important that we are relaxed and open about our identities, and that we recognise why that process of “othering” arises so easily within all of us. It’s a trap that is easy to fall into, and we need to resist it.

Appiah doesn’t mention healthcare in particular. But if we apply these ideas to the healthcare setting, we can see that a shared identity can help us pull together to meet our patient’s needs, in what are often increasingly challenging circumstances. Equally, there can be a process of “othering” which operates, whether it is towards our patients, our managers, our employees, or other agencies. Whilst understandable, “othering” can prevent us fully engaging with the “other” in a way that leads to the best outcome for all of us. This is relevant to our aims to provide person-centred care, and to integration with other agencies.

On the question of nationhood, Appiah isn’t against nationalism, so long as it is an “open, civic nationalism”. His favourite idea of nationhood, however, involves 2 concepts. The first is patriotism, defined as concern with the honour of your country [or countries]. This means feeling proud when your country does something good, and ashamed when it does something bad. The second concept is cosmopolitanism, which means being a citizen of the world. These can combine to form a “patriotic cosmopolitanism”. You can, and should, respect both “the local” and “the global”.

Identities connect the small scale, where we live our lives alongside our kith and kin [and healthcare colleagues], with larger movements, causes and concerns. Our lives must make sense at the largest of scales as well as at the smallest. We live in an era where our actions, both ideological and technological, have global effects. When it comes to the compass of our concern and compassion, humanity itself is not too broad a horizon. We live with 7 billion other humans, on a small, warming planet. The concept of cosmopolitanism has become a necessity.

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Appiah with Obama

Appiah argues for a tolerant, pluralistic, and diverse society. He says, failure to accept this is not just a failure to understand human identity, it is not in our collective self-interest. We do not need to abandon identities, but we don’t need to be divided by them either. Ultimately, the identity of “being human” ought to transcend all others.

As Scout, the young heroine in the novel about race and mental illness, To Kill a Mocking Bird, concludes: “I think there’s just one kind of folks. Folks”.

The Reith lectures are available to listen to on the Radio 4 website, indefinitely.

Dr Dawn Renfrew is a Consultant Child and Adolescent Psychiatrist for NHS Dumfries and Galloway