Member voices: Three responses to Covid-19

Q1- Please introduce yourself and tell us how you first got involved with UK-Med.

I’m Kirsty and my primary role is as a Paramedic.  I got involved in UK-Med during a long and quiet night shift many years ago, I was browsing the web and came across the UKIETR and signed myself up. Many years went by, until Ebola in 2014-2015 when I got an email saying ‘can you help?’. I responded straight away with a yes and deployed with UK-Med and Save to Kerrytown Ebola Treatment Centre in Sierra Leone working as a clinician, treating Ebola patients in the red zone. Whilst there I also took on the role of Medical Co-ordinator, working to admit & discharge patients. It was a hugely challenging and rewarding experience. Many of the team I deployed with I know are on the UKEMT register.

I came back from Sierra Leone and wanted to get more involved in the UKEMT. Whilst attending a members event in Manchester I was chatting to Richard Dear the UK-Med Logistics manager, and mentioned my interest, that was in September 2017 and by November, I was on the first of many Deployment Courses (DC) as logs assistant. I have gone on to develop my humanitarian medical logistician knowledge by completing a funded med logs course had the opportunity to work on developing the reconfiguration of the field hospital. I’ve attended many other courses provided by UK-Med, and spend many happy hours in a slightly cool warehouse working to maintain the medical supplies for the field hospital.

My name is Angela and I am a dual Portuguese and British critical care outreach and humanitarian nurse with nine years of progressive experience in healthcare, seven of them under the NHS in the UK and the remaining two within the international field.  Throughout the year of 2018, I worked for the United Nations peacekeeping mission in Mali in the remote and volatile region of Timbuktu.

I joined UK-Med in 2015, at the awakening of the West Africa Ebola outbreak. Undertaking the Ebola Response Pre-Departure Training for Sierra Leone and the Overseas Training Deployment to Malawi significantly shaped my understanding of an emergency response for a high consequence infectious disease. Responding to the worldwide call for international assistance in the global pandemic of COVID-19 was the natural thing to do.

I’m Marc and I am currently working as a Critical Care Nurse at The Royal London Hospital, an internationally renowned tertiary hospital which is part of Bart’s Health NHS Trust. I have also worked and gained experience at other leading trusts including the Children’s Cardiac Critical Care Unit at Great Ormond Street Hospital and the Adult Critical Care Unit at University College London Hospital.

When I was asked by my career’s adviser as a teen “what do you want to be when you grow up?”, apart from not wanting to grow up too much, I was torn between a job that involved care and one that combined travel, culture and working in challenging environments. Therefore early in my career I got involved in global health and expedition Nursing which has taken me all over the world taking part in skills development and capacity building projects across south America, sub-Saharan Africa and East Asia. Like many Health care professionals, I felt traditionally you were expected to choose between these two career paths. So five years ago I started looking for an NGO that would enable me to balance pursue both my passions and that’s when I found UK- Med. Since joining I’ve taken part in numerous training programs, joined on-call team registers and deployed with the UKEMT in November 2019 responding to the Measles outbreak in Samoa.

Q2- What is your current job and what you have been doing to combat COVID-19? 

Most recently, I have been working at Nightingale North-West as the IPC Lead. My Paramedic work is predominantly based in West Cornwall but when the outbreak struck I was based for very happy personal reasons in the North West. The Ambulance service there wasn’t able to find me a role so I contacted David Anderson the UK-Med Health Advisor to ask if he knew how I could help. For me, not being on the front line as a medic during this outbreak felt uncomfortable, knowing my colleagues are out there in very difficult circumstances.

The next day I was at the Nightingale! David and I had worked closely together with the Medical logistics side of things for UK-Med so a few days later I had taken over a portion of his role at the Nightingale. Initially, I was primarily training and contributing towards core inductions in both light & heavy PPE, I was also swiftly trained to fit test staff in FFP2/3 masks. Now that role has developed into assisting the exec team in IPC assurance and auditing & policy development. I am currently assisting in the standby/down process to ensure the hospital is prepared both practically and policy based for re-commissioning should it be required.

I deployed as part of the UK EMT which stands for Emergency Medical Team to support the response towards COVID-19 in Burkina Faso. I focused my relief efforts in Infection and Prevention Control in a dedicated hospital in the capital city of Ouagadougou, developing a five-week plan to reinforce their infrastructure capacity and staff training to cope with the influx of patients. This was achieved in collaboration with a NGO named Alima, the Ministry of Health and the WHO on the ground. The most challenging but most rewarding element was liaising with the different stakeholders to streamline the response in Burkina Faso. Some of the innovations introduced included an improved triage area to increase the number of patient seen and a staff training program in basic infection prevention and control strategies. Read more about our Burkina Faso response here

Just before the declaration of the COVID-19 pandemic, I had been working as a Seconded Advanced Nurse Practitioner in the Emergency Department at The Royal London Hospital. In the early phases of the pandemic, I supported screening programs and the management of the initial patients arriving with suspected cases-, particularly those requiring critical care interventions as well as providing health education and working to reduce community fears.

My primary role is as a senior clinical site manager and I have been involved in the organisational management side of things. Specifically, how we as an organisation would effectively manage the surge in patients. Other areas of work have included managing setup of the satellite critical care areas, the safe transport of patients and the embedding of redeployed staff who maybe unfamiliar with critical care. Due to a personal interest and from learned experience on various deployments, I am particularly passionate about staff well-being and psychological safety. I drew upon many tactics and methods from UK-Meds’ fantastic and thorough training programme, and from the leadership experience I have gained during my deployments with the UKEMT and other challenging expeditions.

Q3- What is different about your role during the pandemic and how have you had to adapt your normal working practises?

Well for one, I’d normally be the one wearing the mask! My role has differed significantly to say the least. I have had to adapt and learn very quickly NHS managerial styles and practises which is a very new world for me, for example I’d never heard of governance ratification until recently,  but I’ve felt so well supported by the exec team and the whole team at Nightingale North West.

The nature of the pandemic and working within a a field hospital means that in most cases there’s no time for the really considered and stringent NHS processes so the experience and ability I’ve gained to make rapid decisions in those contexts previously is a massive advantage. Rapid decision making, problem solving and doing the best in a crisis situation- those are my skill sets. Therefore I bought in these skills into the new environment and I’ve found people are actually turning to me for advice having had more IPC experience and first hand working in environments where PPE is critical. So that has felt very different, becoming the “expert”.

I feel that any healthcare role in a pandemic context requires resilient up-skilling in a limited time frame. After all this is a novel virus that brings novel policies and practices. As an example, not only UK, but also across Europe and the rest of the world, healthcare facilities had to create additional critical care bed capacity and healthcare leaders had to train professionals to work in an intensive care environment in a short period of time. Up-skilling is indeed a core quality when responding to a novel situation.

My role was not any different – starting from having a new position, deploying to a new country with a new culture and working with new stakeholders. But as it is for all responses: acculturation and collaboration were the key. When teaching I had to take human factors into account, being mindful about the cultural and environmental differences, adapting accordingly. An objective of one teaching was to identify the most difficult part of dealing with this pandemic to purposely get a sense of staff well-being. These sessions were kept short in a ventilated room to help staff stay concentrate in extreme heat which is a major challenge in Burkina Faso. I taught but I also learned from others whilst teaching in a characteristic context.

For the duration of the pandemic I have been redeployed back to support the Adult Critical Care Unit. There has been a particular ask to draw on my experiences of disease outbreak and supporting healthcare systems which are at risk of becoming overwhelmed or underfunded for the task at hand. One particular success was using the training and methods of well-being support. We implemented the UK-Med model of support using ‘buddy systems’, daily personal well-being ratings and guidance of dealing with ethical dilemmas. Other examples include the dynamic “can do” approach to leadership and management seen in global health nursing which is often complicated by red tape and process in national healthcare systems.

The most obvious and enormous adaptation for all healthcare staff has been how to manage communication with vulnerable patients and their families while wearing full PPE as well as dealing with visiting bans especially in end of life scenarios. For me this has been about approaching each situation compassionately and utilising a dynamic approach to create emotional connections and bonds. I really hope that it has been some comfort to those families that can’t visit to know that every person in our care was never alone. In global health nursing I have found that being clear in a few core nursing values has been paramount in preventing personal moral injury something that is normal in war zones or natural disasters. I am hoping that by sharing this approach with my colleagues who have never worked in such contexts, the care of our NHS staff and patients can improve.

Q4- Do you think your UK-Med experience has or will help you to better respond to the pandemic? If so, how?

Yes, in so many ways. In the context of UK clinicians they very seldom need to practise very high levels of PPE , so the first hand experience of receiving the training through RedR for the Ebola response then also the 5 weeks in country wearing PPE everyday was a massive advantage. It provided me with the practical know-how of what it feels like to be wearing that and the physical barriers of how you relate to patients whilst wearing that level of PPE. I used to have a dance that I did when I went into certain wards of the Ebola treatment centre so they knew it was me, the patients would recognise my poor dance moves. It worked a treat in helping to break down barriers.

UK-Med has also given me the opportunity to work and train alongside all walks of NHS clinicians from Consultant Surgeons to Nurses. Having hung out on DC’s with them in the rain and snow in a muddy field eating a rat pack by torch light means there are few barriers when I meet NHS staff. This has given me the confidence to speak my mind and offer suggestions during the pandemic without feeling as though there is a hierarchy between staff. The Nightingale is also the most luxurious field hospital that I’ve ever witnessed! But from the perspective of the majority of UK clinicians who may never have experienced one within a disaster response or international setting it is an adverse environment. Therefore having the previous experience of working in a field hospital with UK-Med has been a huge advantage and I’ve felt rather at home.

Absolutely! The training and experience with UK-Med has given me the knowledge and skills to deploy worldwide, not only from a healthcare perspective, but also from a safety and security one. I remember vividly two of the most valuable lessons being the thorough PPE training when training for Sierra Leone and how to prepare an emergency bag with all the essential equipment to take in case of a security incident when training in Malawi. Those lessons have stayed and will stay with me for life. I have used them ever since in all missions. It is a clear example of how UK-Med training can prepare you for a humanitarian career.

UK-Med has enabled me to maintain my NHS career and engage in many global health projects concurrently. The flexibility of UK-Med has also enabled me to build relationships both within and outside of the organisation which has been an invaluable resource during the pandemic. These introductions and collaborations are the key successes of my relationship with UK-Med. This is important for me, as I believe not all global health work needs to involve travelling overseas.

Most recently, I was deployed with UK-Med and the UKEMT as a Critical Care Nurse and Staff Health Lead in response to the deadly measles outbreak in Samoa, a beautiful island in the Pacific. I gained so much from this deployment including spending time and learning from senior deployment leaders and members of the World Health Organisation. Being able to draw support and advice from the many experts within UK-Med and its partners has been invaluable and uplifting during this pandemic. During the deployment I also learnt about surge management in infectious disease outbreaks and gained a deeper understanding of how to embed respectfully with other healthcare systems. Reflecting on these experiences during the COVID 19 pandemic has enabled me to better support staff and ultimately improve patient care and safety.