Being there for others

Georg Greiner, a German scientist and doctor, way back in the 1880s, is credited with first describing ‘brain fog’. In the language of the time, he described this state as a ‘fogging of the light of reason’ and the ‘clouding of consciousness’ – two descriptions which to my way of thinking, sound so much more illuminating and compassionate than ‘brain fog’. So, while we might think about ‘brain fog’ being a relatively new phenomenon, brought into prominence by the Covid 19 pandemic and the spectre of long Covid, the term and what it represents has been around for a long time.

For some people it can be a passing inconvenience; for others a very debilitating and long term problem and can seriously disrupt people’s ability to work or undertake even the simplest of daily tasks. Whether it is a short term or long term problem, ‘brain fog’ should not be confused with the memory loss and cognitive decline associated with dementia. During the 1990s it was most often associated with the conditions of chronic fatigue syndrome and fibromyalgia. As noted above, as well as being associated with long Covid, it has also more recently been described as a common symptom of the menopause. And last week I felt extremely menopausal.

Of course, I wasn’t! Whilst there is such a thing as the ‘male menopause’, this is a term dreamt up by the popular media. The real associated male health problem is andropause and although like the menopause, it is a condition associated with reduced hormone production, the systems and impact on a man’s life are very different to those experienced by many women travelling through menopause. What was making me feel ill was simply jet lag.

For the first time in as long as I could remember, last week I struggled with jet lag. And my jet lag mimicked some of the signs and symptoms of ‘brain fog’. At times I struggled to focus and concentrate, I felt totally exhausted, I was even more irritable than normal, had real sleep issues and I felt utterly deflated. Doing anything physical, however small, was a trial. I moved like an old man. I felt really out of sorts at times. However, gradually over the week, all the symptoms, apart from the tiredness began to fade, leaving me feeling more like my old self.

Like many minor health complaints, it was self-limiting and time, rest, good food and sleep all helped. However, whilst the menopause is a natural physiological event, last week really brought home to me that many women going through the menopause will often experience similar symptoms over a much longer period, a lived experience that is likely to be very debilitating over time. When one considers that the average age in the UK for women to experience menopause is 51 years old, the impact on people’s lives can last for many years. It is a growing problem. It is estimated there are some 13 million women who are currently peri-or fully menopausal in the UK. That is equivalent to one third of the entire UK female population.

We also know that up to 50% of women, aged 45-65 years old, go through the menopause without ever once consulting a healthcare professional, despite the fact that women also report that the menopause had caused them problems at home and work. Likewise, it’s true that there is a big market in over-the-counter medications that people can use - how effective these might be is probably down to the individual.

Whether a woman self-cares or seeks the help of healthcare professionals to manage their menopausal symptoms, women in the workplace should expect to have a range of reasonable adjustments available to them in order to mitigate against unnecessary sick leave or absences. Apart from the duty of care we all have towards our colleagues, putting in place practical and emotional support as well as training managers to become ‘menopause aware’ makes sound financial sense. Last year it was estimated that the economic cost of sickness absence, informal care giving and health-related productivity losses was over £100 billion a year. Inevitably some of these costs will reflect women working in organisations where little is available to support those experiencing menopausal issues. I’m very proud to say that, in my NHS Trust, we took the decision to put in place a range of supportive measures, most important of which was the training of line managers to enable them to respond in an informed and compassionate way to colleagues experiencing menopausal problems on a day-to-day basis. There are many resources available to help organisations find better and more effective ways of supporting their staff through the menopause.  

Last week, I also experienced, indirectly, that support. I had been asked to take part in a memorial service remembering the 22 people who lost their lives six years ago in the dreadful Manchester Arena attack. The service was last Monday morning. And I wasn’t feeling at all well. However, we held the service outside in the sunshine in a quiet and secluded spot on the hospital campus. Colleagues who had been on duty that night and who helped so many were part of the group gathered to remember. As we prepared ourselves for the service, my fatigue melted away, by 'brain fog' cleared, and by the time I came to read the memorial poem, I felt like a different person. The feeling didn't last but in that moment, just being with others is all I needed to feel myself again. It is the little things that can sometimes make the biggest difference, although we won’t always know this at the time.  

Learning to walk: the Gonzales way

It is wonderful to get away and to be able to do something completely different for a while. It is also lovely to be back home. Yesterday was our first full day back from our trip to Peru. The jet lag was making its presence felt, so we decided upon a fun day out in Blackpool. Yes, some readers will know we live just outside of Blackpool itself, so what did we do that we haven’t already done. Well, we went up the Blackpool Tower for a start. After living here for over four years, this was the first time we had done so. 

It was a fabulous experience, and I loved the glass floor, with its view straight down 400+ feet to the Comedy Carpet below. We took a trip on the top deck of one of our beautiful heritage trams to Fleetwood, had the obligatory cone of chips and cup of tea, before returning to sit in our (slightly overgrown) garden for a refreshing glass of beer in the sun. It was the perfect antidote to jet lag.

Possibly it was because I was drinking a pint of Wainwright’s Golden Beer as I sat there, that I began to wonder exactly when it was that I had walked Wainwright’s Coast-to-Coast walk. Was I 50 or 60? I knew it was around a landmark birthday. J supplied the answer by looking through my old blog posts and found this one, which clearly indicates it was in celebration of my 50th birthday. That was 18 years ago! 

Reflecting upon this, I’m amazed at the passage of time and all that has occurred since then. Don’t worry dear reader, I’m not going to reminisce, (I’m saving that for my 70th birthday) but back then I was able to walk at 4 mph, uphill and down dale. It took me 12 days to complete the walk, on average 15-20 miles a day. These days, I’m fortunate to be able to walk at 3 mph, but I do walk every day.

However, last week, even this mileage pace was challenged. J and I had gone to Peru to fulfil one of her dreams of walking the Inca Trail and seeing Machu Picchu. We set up a punishing training schedule and for months we had trained extensively. In J’s case this, of course, consisted of buying new walking clothes, and in my case, scouring the supermarket shelves for Peruvian wine. To say we were unprepared for walking at altitude would be an understatement. Flying in to Lima (a 12.5 hour nonstop flight) we were seduced into thinking all was well. A few days later we flew to Cusco, which is 3,400m above sea level. That is when we first encountered high altitude and all that that entails.

High altitude starts to have an effect on our bodies from 1,500m. To put that into context, Ben Nevis, and Snowden, Britain’s top two highest mountains, are just 1,345m and 1,085m respectively. Undoubtedly, walking up either is tough going, even for fit folk. In Cusco, J and I struggled to walk up the high street to the city’s main square. The air was so thin that we literally struggled to put one foot in front of the other and as we did so, our headaches grew worse, our breathing more laboured, we felt dizzy and at times confused and progress was miniscule. After Day 2, things eased a little, but walking anywhere was hard. Stupidly, after making a massive effort to walk up to see the White Christ, (a one third high replica of the art deco statue of Jesus Christ in Rio de Janeiro) that overlooks Cusco, and adding another 100m to our altitude challenge, we celebrated with a Pisco Sour.

This is a famous drink in Peru. It is very drinkable cocktail. Apart from the Pisco spirit, it is made with crushed ice and egg whites. Unthinkingly and emboldened by our uphill walk, we had another and several more besides, before calling it a day. The following morning, I felt a deep rumbling in my bowels, the consequence of which was a rather explosive first visit to the toilet, a situation that stayed with me for 6 days. J, was unaffected and continued to drink Pisco Sours whenever we stopped for a break.

We had a few days exploring the villages and sites of the Sacred Valley, which wasn’t as high an altitude as Cusco, but at 3,000m was still pretty challenging. The day eventually dawned for us to do the Inca Trail. We chose the Short Inca Trail (I like to sleep under 5 stars, not 5,000 stars) and the starting point of our trek was 2,000m. Over nine miles we would walk up to the Sun Gate and Machu Picchu, some 2,700m high. We were told it probably would take us 7-8 hours to do the trek*. Now let me introduce Gonzales. He was our guide. An enviably slim young man, who dressed immaculately, oozed self-confidence and had a black SwissChamp army knife attached to his rucksack (those who know, will know).

Before we set off, he gave us a pep talk, took us through some warm up exercises and reassured us that we would, to start of with, walk 50m before taking a short rest break. A bit over the top I thought, but as I still had raging bowel problems, I thought ‘okay’. We fell into line, and I walked directly behind him. I noticed that he was wearing what looked like a pair of yacht deck shoes rather than walking shoes or boots, and he took incredibly purposeful, slow, shallow strides. Almost like he was putting one foot in front of the other, and repeating this in a fluid continuous movement. I found matching his pace very difficult. However, that first 10 minute pause when it came was so welcome!

And that is how we continued, for hour after hour, getting higher and higher. It wasn’t all up hill either. Sometimes we plunged down, knowing that we would have to recover the height eventually. J, who despite her extensive training programme, had some last minute collywobbles over her ability to complete the trek, did superbly! She became the group’s darling by redoing her makeup and hair before moving on after each break. I felt proud to be walking alongside her as we finally completed her long-held ambition together, and walked through the Sun Gate to get our first glimpse of Machu Picchu.

The Gonzales Pace. It worked for us in Machu Picchu, and I have kept it going here on our return. I feel privileged to have reached a point where a slowed down approach to life feels acceptable and preferable. Not sure how this might continue to manifest itself, but Gonzales Pace is here to stay.   

 

*we did it in 6 hours!

The Inca Trail, the Incas Tale and possible lessons for the NHS

One of the things I love to do is people watch. Find a pavement cafe, sit down with a glass of wine and watch the folk walking past. As I do so I try and imagine what is going on in their lives.  Of course while you can see happy smiling faces, or sad or angry  faces, from the vantage of my table, I will never know what is going on in their lives. It takes a rather more serious form of study to do that. And observation is key to study of this kind. It’s part of something known as ethnography, the long established scientific study and description of people and cultures. It’s an approach used by many who study cultural anthropology. It was an approach I used when undertaking my PhD. Indeed I pinched my thesis title from the famous Max Gluckman’s Customs and Conflict in Africa, to Customs and Contracts in the GP Fundholding Family. My thesis explored how different members of the primary health care family used a range of relationships to achieve their objectives in an highly prescribed and regulated health care market. All of which is by way of an introduction to sharing my experiences of last week. 

I’m excited to say that this week’s blog comes from Peru. J and I have celebrated our birthdays, walked the Inca Trail, explored Machu Picchu, the Sacred Valley and sat on the magnificent shores of the Pacific Ocean in Lima. It has been a wonderful trip, particularly as we have enjoyed some great guides keen to share the history of Peru - and goodness, it has been a checkered one too. At its height, the Inca Empire was the largest in the world. There were estimated to be some 20 million Incas. We have seen, and walked on some of the most amazing structures I have ever seen. When you think the Incas were around from 1438 and didn’t know what a wheel was, some of these structures are immense and wonderful pieces of engineering. The Inca stone work is civil engineering precision taken to a new level of achievement. 

We did also hear some weird and wonderful stories of their ingenuity too. They discovered how to freeze dry potatoes and seeds. These potatoes have all the moisture taken out of them and could then be stored for at least 10 years of more. Likewise, there were some other peculiarities that just felt alien to us. For example, guinea pigs are a great delicacy here in Peru, as are Alpaca Sunday roasts. The Incas had a wonderful system of taxation, paid partly in money and partly in labour. Everyone was compelled to participate. It has been said that even the beggars on the streets had their lice taken in lieu of their taxes. They were able to build such a large empire not through force, although there were countless battles, but through collaboration and persuasion. To be honest, at the time, it was better to be part of the Inca empire than be outside it. 

But this wonderful balanced way of life started to unravel with the arrival of the Spanish Conquistadors. They came at first to see what Peru and the Inca empire had to offer (what they could take for themselves, and then returned 7 years later intent on colonising the empire and taking its wealth. They were able to do so as the Inca people had never seen horses, let along armoured horses, which they thought literally ate metal, nor had they seen guns. Francisco Pizarro who led this colonisation was, himself a fearsome man. His statue in one of the parks in Lima show just what a fearsome sight he must have been. So with a relatively small force they were able to overpower the Incas. By 1572, the Inca empire was no more. 

Now you might be asking what has any of the above to do with our UK health service - a good question. Well the Peruvian health care system has considerably improved over the past 20 years As we have toured around we cam across many primary care centres and mini hospitals (akin to our walk-in, urgent care centres). Even in the deepest parts of the countryside they were to be found. However, and a bit of throwback to my PhD thesis, in a lot of the mountain villages you can still find Shamens dispensing health care. Peru spends less per head of population than all the other Latin American countries, but equally, and unusually, spends much less on defence. Of course I don’t know how effective the health care provided might be, but the infrastructure looked pretty good. 

However it was the fact that they were able to provide and nurture such a large population, and to do so well, mainly through collaboration and working for the common good that really struck home. In the UK we now have Intergrated Care Systems (ICS), that bring different health and care organisations together in working more collaboratively with each other. Not to just provide for better health and social care but to prevent many more people from needing the services in the first place. I think in many parts of England, the jury is out on whether we can define and promote what the great good might look like. I think we have a short window in time to really come together in making a difference. If we don’t I think the ICS might well will go the way of the Inca empire.

The King and I blog

Well, this week’s blog is coming from Terminal 2 at Manchester Airport. We are waiting to board our plane; a plane that will take us to Lima, Peru. We are off to do the Inca Trail, and visit Machu Picchu. After the highs and lows of last week, the trek with its many ups and downs along the way, feels somewhat appropriate.  

Despite what I wrote in my blog a couple of weeks ago about the Coronation, one of the highs for me last week was definitely the television coverage. The pageantry, traditions, words, music and rituals were fascinating. I marvelled at the organisation and logistics required to stage such an event. I think most people who watched and listened would absolutely have been moved by the armed forces’ three cheers as they stood in the Buckingham Palace garden. It was for me, a wonderfully emotional moment.

For many people watching or taking part, it will be a once in a lifetime experience. For others, like my parents, it will be the second time they have witnessed a Coronation. And, judging by the paucity of flags and bunting around and about us, there will be others still, who will have had no interest in the proceedings whatsoever.

Given the thousands of people who took part or were there in person, it was also a great credit to all those involved in keeping people safe and well. It was a huge police operation carried out perfectly. I would have thought the potential for disruption or some kind of terrorist attack was a very real possibility. Thankfully the whole day passed off without incident, which perhaps I shouldn’t be surprised at.

However, I was surprised to read in research published last week by the University of Cambridge, of the high number of incidents of violence, sexual harassment, bullying and unacceptable behaviour experienced by colleagues working in the NHS. The paper has an excellent reference list with other papers showing just how widespread the problem is. Of course, there should always be a zero tolerance approach to such behaviours in any organisation. But actually, it can be difficult to challenge such behaviour, particularly when there is a power difference between the parties involved.

It can be like asking patients and visitors on NHS premises to respect the no smoking rule and put their cigarettes out. We all know it’s the right thing to do, but I have yet to find the right form of words that gets the desired effect without being on the wrong end of the person’s verbal abuse. Please let me know if you have found a great way of dealing with this problem. Intimidation can be frightening, even for the most experienced amongst us.

I was interested therefore, by a suggestion in the paper that there is a really great training programme, but sadly few NHS Trusts were using it. The programme is called Active Bystander Training (ABT). I have to confess I hadn’t heard of this programme, and I don’t know if we are one of the few Trusts to be using the programme – finding out will have to wait until I come back from Peru. ABT aims to provide folk with the skills they need to ‘call out’ the kind of unacceptable behaviour noted above. One of the paper’s authors, Dr Sarah Steele, notes ABT should be part of everyone’s training, whatever the stage of their career. It is hard to argue against this suggestion.

However, as great as the ABT programme might be, creating a culture that doesn’t tolerate such behaviour is key. Given the magnificent spectacle of our massed armed forces yesterday, and let’s not forget our King, is the Head of the Armed Forces, it seems somewhat fitting to end this blog on a military note. You may have come across the famous quote by the former Chief of the Australian Army, Lieutenant-General David Morrison ‘the standard you walk past, is the standard you accept’. He has made many YouTube leadership videos, in which he quotes this phrase – have a look at this one here. I just love the unwavering determination in his voice. But now I must leave his blog and get ready to board our plane. WiFi permitting there will be another one next Sunday!