Pygmy elephants, PhDs and Potholes

Well we have enjoyed 10 days of memory making. I find it intriguing, as to how past memories are prompted. For example, the first time I went to visit Hungary, it was on a new European Union ERASMUS agreement made with a similar health faculty at the Pecs University. It was a grand first trip. Many of the folk, I met along the way, are still my friends now. That first trip involved moving from city to city, town to town and meeting nurse educationalists in each place. I was driven everywhere by drivers who spoke little or no English. I spoke no Hungarian.

Regular readers of this blog will know that J and I have spent the last 10 days in Borneo, so what might have given rise to this memory jog? It has probably been the roads we have driven on since arriving in Borneo. For the most part they have been diabolical. Even the ‘motorways’ are littered with roughly filled-in potholes. Bizarrely, we found that even on a short journey, being constantly bumped up and down in your seat resulted in many steps being added on our Fitbits!

Now I first went to Hungary in 2006. That was just two years after the country joined the EU, having previously rid themselves of the Russian occupation in 1991. At that time the roads were just as bad, as those we have travelled on in Borneo. Back then, the journey from Budapest to Pecs (some 210 km apart), where I had a PhD student, would take nearly five hours on those dreadful roads. I have been back a few times since, and the journey now takes half the time on perfect, beautifully smooth, EU-funded motorways.

Like the UK, Borneo is not part of the EU. In those early trips to Hungary ringing home required me to use a land line phone, as my mobile wouldn’t connect with the UK. Just three days ago we sat on the remote Libaran Island, a 45 minute high speed boat trip off the coast of Borneo, where it was possible to pick up 4G reception. And wifi was on its way! The island’s other name, is Turtle Island, and J and I were able to help 35 little green turtle hatchlings into the sea and the start of their lives there. Now that was a once in a lifetime experience.

As well as the turtles, there are five animals that all eco tourists want to see on their visit to Borneo. They are: the pygmy elephant, the rhinoceros hornbill, the proboscis monkey, an estuarine crocodile, and of course the orangutang. By day four of our trip, we had been privileged to have spotted them all. 

For me, the pygmy elephants were the highlight. We were very fortunate. Our guide and boatman had both only seen them three times before this year. It was their knowledge, skill and perseverance that got to us to sit patiently on a small creek in the jungle, hearing the sound of the elephants slowly making their way towards us. When a mature male ambled (yes that is the right word) towards us and out of the jungle, it was simply a magical moment.

Whilst seeing the ‘Big 5’ was only possible with the help of our guides, there was one animal that need no help to be seen - macaque monkeys. These cheeky little monkeys were everywhere. For example, at the Sukau Bilit jungle lodge everyday at 3.30pm, the lodge staff served coffee and cake to their guests. In an almost Pavlovian response, the local monkeys literally poured into the dining area, a large open-sided structure and tried every which way to pinch a piece of cake. Whilst most of the visitors found this highly amusing, the restaurant staff didn’t and occasionally walked around tapping tables with sticks and shooing the monkeys away. The same pantomime was repeated each day. Neither the monkeys or the restaurant staff seemed to be able to break the repetitive pattern of behaviour.

And maybe that was another thing which brought back memories of my visits to Hungary. I had agreed to supervise one of the senior managers in their national health care service to do his PhD. We would mostly do things by email, but we met up regularly to do face-to-face supervision, both in Hungary and in the UK. Doing a PhD is a journey of discovery. Not just to make a contribution to our knowledge, but to discover more about ourselves as people. My student struggled with moving too far away from what he already knew. I struggled to help him. Like our Borneo guide and boatman, I would love to say it was my skill, knowledge and perseverance that got my student over the line, but that would be untrue. Whilst my student did eventually get their PhD awarded, I don’t think it was my finest hour as a supervisor.

After 3 plane journeys and 24 hours of continuous travel, J and I arrived back into the UK at 07.30 on Sunday. We are a little tired and I’m very conscious that I will be back at work tomorrow. I’m sure there will lots of emails to deal with! Over the last 10 months our Trust has moved forward on its improvement journey. Many colleagues have stopped looking backwards and started to look at what is possible in the future. I think there is a real desire now to be always outcome-focused in everything we do, and increasingly, to stop doing what was always done in the past. Like the pothole free roads in Hungary and our sighting of the pygmy elephants last week, I grow increasingly confident that we will also succeed in our journey to becoming an outstanding mental health organisation.

A kind of Jungle Book story

Well after 3 planes, and nearly 30 hours of travel (one plane was cancelled resulting in a tiresome 6 hour wait in a Business Lounge that didn’t serve alcohol) J and I arrived in Kota Kinabalu, Borneo. The temperature is 30c which is lovely, although the 80% humidity does make it feel warmer still. And October is the start of the wet season… …and day 2 we have enjoyed (endured) monsoon rain. The rain continues to pour. The desire to come out here arose from our visit to our local zoo. Until we moved here, I didn’t know Blackpool had a zoo. Nobody in our party is very happy with us talking about zoos but we are unapologetic. Blackpool Zoo is not the biggest zoo ever, but we like it, so much so we became members. As members we can visit as many times as we like, get free car parking and get 30% of our hot chocolate drinks. It also means we can avoid going there when the place is crowded and full of very excited and noisy children!

Whilst we visit every animal and bird each time, our favourites are the big cats and the orangutans. The latter are simply the wisest looking animals in the place. Last year and again this year, two of the mums gave birth to the tiniest little baby orangutans we had ever seen. Indeed, it was several months before we actually caught a glimpse of them.

So, we decided to come out here and see them and many other animals and birds living in the wild.  Whilst on this trip, we won’t be climbing up Mount Kinabalu, for the next 8 days we will be travelling through the jungle, speeding up rivers and perhaps even drinking a glass or two on the beach. We are staying in hotels, homestays, jungle lodges, glamping tents and rain forest resorts. Last night’s accommodation was a little rudimentary but clean and absolutely fine for an overnight stop. I even helped prepare dinner, pineapple curry.

Trips like this take a bit of organising, but the break from the routine of everyday life makes it a worthwhile effort to make happen. Of course, you don’t need to make a 16,000 mile round trip to be able to step off the merry-go-round. We regularly take ourselves off for a day’s walking in the hills. Whereas I’m content to enjoy the same walks more often than not J will choose the walk in order to find a new one to do. She likes to plan, and on the walk, although she can protest loudly, she likes to navigate. Whilst we nearly always get lost on our walks, this is usually down to me rather than her navigating skills. I rely on intuition, J relies on maps and tried and tested directions.

Being able to plan something different, and then having a go at trying to achieve it, can, in itself, be helpful for maintaining our mental wellbeing. If this is something new, even better.  A few weeks back, J organised an eight mile circular walk, which at the halfway point delivered us to the ‘Singing Ringing Tree’. This was situated on top of Crown Point overlooking Burnley in Lancashire. It is a stunning bit of art. A sculpture made up of different lengths of round metal pipes, shaped like a tree that has been bent by the wind. As the wind blew, and passed through the pipes it created a sound similar to the singing of whales as they call to each other under the oceans.  

It is a truly magical place. We lingered, J noting that it would be a great place to practice her mindfulness. Again, something we can all try and do to enhance our mental wellbeing. Back here in Borneo, sitting and listening to the rain falling and the many night sounds of the jungle is equally a great opportunity to simply relax and let your mind rest. I also like it because it feels like being off the grid. My NHS organisation blocks emails when colleagues are out of the UK. They simply don’t land in your inbox (although they are all there waiting for you when you return). It is a brilliant strategy for leaving all my work stress back in Manchester. I need to improve the amount of time I don’t turn my phone on when I return when I get back. I once had a mentor who reminded me on more than one occasion that however much we might think it’s the case, none of us are indispensable.

So for the next few days, I intend, literally on some occasions, to just go with the flow (got 3 river trips planned). As a consequence, it might mean that my blog gets posted at an unusual time, or heaven forbid, even not at all. This week’s blog has been posted while most folk in the UK are taking a Saturday afternoon stroll, so I apologise if you missed my posting . I will see what I can do later.

Horse tales and other lessons learnt

My first NHS Non-Executive Director role was at Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust. I was blessed with a great Chair and CEO and over the seven years that I worked there, I learned a great deal from both these wise and generous men. Unusually, they both became friends, as well as colleagues. I think some of the most important lessons I learned from my time with them were: to always remain curious, to always consider the impossible when looking at solutions to problems and the importance of being able to communicate with whosoever you met.

 

That was a while ago now, but I continue to benefit from their insight. Sadly, the CEO, Andrew Foster died in March last year. Like many folk, I still miss him. Even when he and I left WWL, we would periodically meet up, have a couple of beers, and put the world to rights. We would meet halfway between his and my house, at a pub situated on the banks of a river. During the summer, you could sit on the terrace and it was a lovely way to spend a couple of hours. These days, I still pass the pub on a regular basis and each time I do, those memories make me smile. 

I was reminded of Andrew twice last week. The first occasion was during interviews for our last Board position, Director of Corporate Assurance. The successful candidate also worked at WWL, and we were able to have a bit of a catch up as well. The second occasion followed my reading of the story of Peyo, a therapy horse who works in a palliative care centre in northern France. Amazingly, Peyo ‘tells’ his trainer, Hassen, which patient he wants to visit, by standing outside that patient’s particular door. The horse appears to have the ability to recognise when a person has a tumour or cancer and has a wonderful ability to ‘be with’ people and reduce their pain and anxiety, as they near their end of life.

 

After performing at shows, the 15-year old horse would often seek out the company of people and stay with them. Hassen began to suspect that Peyo had special powers, and after nearly four years of investigation, vets now believe his brain functions in a unique way. Now some readers might be forgiven for thinking that possibly my mind functions in a unique way in making a connection between Peyo the horse and Andrew Foster, the Chief Executive.

 

Once, while I was at WWL we had a 77-year old patient, who was receiving end-of-life care for cancer. She was called Sheila Marsh. Although Wigan is part of Greater Manchester, it is surrounded by some wonderful countryside. Sheila lived in this countryside and had kept show horses for many years. As Sheila neared the end of her life, she told the nurses looking after her that her dying wish would be to see her favourite show horse, Bronwen, one last time. Andrew, his Director of Nursing and the family agreed to try and make this happen.

 

As Sheila’s condition deteriorated, the family arranged for Bronwen to be brought to the hospital. Staff wheeled Sheila’s bed outside and Bronwen walked straight over and started nuzzling Sheila. It was a very moving moment captured on Andrew’s phone. It was a photo that went viral when he posted it on social media. There were lots of tears, but smiles too. Her family said the moment was truly wonderful and had brought comfort to their mum. Sheila was to die just a few hours later.

Across all types of health care, it can be hard sometimes to measure the real outcomes of the care provided to patients, service users, and carers. With Sheila, there was no cure for her cancer. However, I like to think that the care Andrew and his colleagues, and Sheila’s family provided to Sheila eased her passing.

Inevitably, we will all die. For some people, death will be sudden and unexpected. However, for many of us, there may well be time between when we know that we are facing a life-shortening condition and actually dying. It is during this time that planning for a good death is important. Many folk don’t like to talk about dying, and it can be a difficult thing for individuals and their families to get into. Equally, many health care professionals can find it difficult to talk with the people, who are facing the end of their life. 

However, trying to find out what really matters to a person dying is critical if their preferences, wishes, and beliefs are to be met with care. I believe that doing so is as important as is the physical assessment and planning of care to keep people pain free and best able to cope with other physical problems they might experience. As with many aspects of health care, good communication is what will ensure a person’s physical, emotional, and psychological needs are met in a person-centred way. 

The story of Bronwen illustrates to me what might be possible when those lessons of always remaining curious; considering the impossible when finding solutions to problems; and the importance of effective communication with others are foregrounded in the way we think about providing care for others. I thank all those who so generously and freely provided me with so many opportunities to learn. 

A happiness filled blog

This week’s blog was inspired by a simple voice message sent to J from our youngest daughter last week. She had started her message by saying she had ‘just experienced true happiness’ – listening to her message, happiness seemed to stem, in part from her taking delivery of one of those whole-body electric blankets with sleeves. It takes all sorts but if being snuggled down in a warm top to toe wearable electric blanket makes her happy who am I to comment. It did make me think about all those things that bring me happiness too.

For example, I had been really happy with the rather mixed weather we have been enjoying; as has our garden. Then suddenly, we are at the start of October. There was me making the most of the September sunshine and suddenly, we are in October with its shorter days and colder mornings. However, I’m not complaining. Both J and I won on our Premium Bonds this month. As she has just had a massive clear out of her wardrobe’s (yes you read that right more than one wardrobe) she was very pleased to have received her windfall. I’m happy because J is happy. The local charity shop was also happy to receive a van load of her clothes.

I bought another guitar with my prize money – a custom built 3 stringed cigar box guitar, which is ideal for playing slide guitar blues. Billy the parrot is happy as he loves whistling the blues.

More importantly the early days of October also brought and opportunity to have both my flu and covid jabs yesterday. It is always a relief to get them done early. Wearing my public health and health promotion hat, I would urge every reader of this blog and their families to get the jabs done too. The new Covid variant is much more like an intense flu and is laying folk low very quickly. This new variant typically results in a high temperature, a persistent cough, an aching body and a constant headache. If you get it, I guarantee you not going to be feeling very happy.

Thankfully, whilst giving rise to horrible symptoms, this variant is not so deadly as some of the previous one. That said, in the week ending 21^st September 2024 there were a total of 9421 deaths registered across England. This was a ‘quiet’ week for deaths, with there being some 1500 less than was expected.  However, of the 9421 deaths, 1450 were the result of influenza (flu) or pneumonia, and 235 were a result of Covid 19.  So, if you are eligible, get your free jab or if not eligible for a free jab, think about the cost of paying for it as being an investment in your future happiness and wellbeing.

Tuesday gave me the opportunity to both briefly look backwards but more importantly to look at our future as an NHS Trust. It was our NHS Trust Annual Members Meeting and my first one since taking up the Chair role. I love these kinds of events. I’m never happier than when I’m on a stage, and I have been fortunate to have enjoyed performing on many stages in my time. Last week was no exception and the meeting was a fabulous one.

We did the serious stuff of course. We have to. Whilst the AMM is a formal meeting in some respects it is also a great opportunity to share with our members (folk from across our various communities) what we have done, its impact and the difference made. It is also a chance to share where we are heading on our improvement journey. Two of our clinical services gave presentations that illustrated all these features. I was more than happy with how the afternoon went. Feedback from other attendees, tells me many of the people who attended were happy too.    

On the Wednesday I made a presentation to thank our out-going Chief Nurse for her contribution to the Trust and the wider NHS. I think she was both a little sad at retiring, but happy too in terms of what opportunities retirement might bring. I was surprised, and very happy to bump into someone I hadn’t seen for many a year at the event, a chap called Malcom Rae. Many nurse readers of this blog might know the name, if not the person. When I first joined the Trust in 1984, he was the Chief Nurse. We didn’t always see eye to eye, but he generously helped me progress my career, and for that I will always be grateful. He provided a way of helping others that I’ve been happy to emulate every since. I hadn’t seen him since I left the Trust in 1998. Meeting him once more last week gave rise to my own ‘experience of true happiness’.