Senior Researcher and Consultant Gynaecologist
MRC Centre for Reproductive Health, University of Edinburgh
“Thus we never see the true state of our condition, till it is illustrated to us by its contraries; nor know how to value what we enjoy, but by the want of it.” Daniel Defoe, Robinson Crusoe
TL;DR: The direct and indirect effects of COVID-19 disproportionately affect the least privileged in society. As healthcare providers, we need to be organised, streamline our systems and rethink our services.
Winter turned to spring and the UK entered lockdown. As doors were shut and toilet roll was stashed in cupboards, I began to attempt to do my research from home and my two pre-school children became my “co-workers”. Cue meltdowns about snacks as I tried to chair meetings, insertions of random text in the manuscripts I was writing and declarations of defecations during remote international conference presentations.
I left the house three days a week to navigate a hospital filling with Covid-19 positive patients, help reorganise our clinical services and deliver emergency gynaecology care. Ruptured ectopic pregnancies, twisted ovarian cysts and torrential heavy menstrual bleeding don’t stop for pandemics. PPE, handwashing, Do Not Attempt Resuscitation (DNAR) forms; so many difficult decisions. My husband wrangled with the children at home whilst working full time; his job busier than ever.
But we were fortunate. I could continue to provide medical care to patients as I was healthy. Although anxious for myself and my family, I wasn’t terrified of dying from Covid-19 if I caught it at work. The public rallied behind NHS workers and it lifted my spirits to see the rainbows and hear the claps. As happens all too often, the least privileged in our society were hit hardest. Therefore, I don’t want to focus on my story, but share the direct and indirect impact that this pandemic has had on the people whose voices are less often heard.
A mother of three was unexpectedly pregnant. She lived with her partner and children in a one bedroom high-rise flat. Her neighbour was admitted to hospital with Covid-19. She was afraid it would spread through the block. Against advice, she had brought all her children with her to her routine scan appointment, “Sorry, I didn’t want to stress him out with having the kids”. She had unexplained bruises on her thighs.
A young woman attended hospital requiring emergency gynaecology care. She had acrimoniously split up with her boyfriend and moved out of their shared flat. Due to lockdown, no flats were available to view or rent. She was living on the street. “How about moving back in with your parents?” I naively enquired. She would rather live on the street. Eighteen years of sexual abuse from her stepfather removed that possibility.
A woman required an emergency operation. Her family were made homeless just before lockdown. They were living with her elderly mother and father, who were both shielding due to chronic illness. Her family of five were all sleeping in the one spare room. She was petrified of being in hospital and taking an infection home to her family. Her guilt was overwhelming.
A pregnant woman’s swab for Covid-19 was positive. Thankfully, she was stable and did not need admission to hospital. She was terrified about the effects on her baby. I didn’t have answers for her questions. I couldn’t provide the reassurance she so desperately wanted and needed. “So far, we haven’t seen very negative effects” didn’t cut the mustard.
A woman with endometrial cancer required an operation and chemotherapy. She lived with her son and his family. Two of them were high risk key workers. She didn’t have the means or physical capability of living alone but her mind was sharp, “So doctor, my choice is either to delay the treatment that might save my life or go ahead with it and take my chances with the virus that will probably kill me when my immune system is down?”
As healthcare professionals, we regularly see the wider socio-economic inequalities that exacerbate health problems; but this pandemic has thrust these issues into the limelight. If there is a silver lining to Covid-19, I hope it is that health services, governments and society now address these inequalities through reform and new investment. Support for the NHS has shifted into discussions about its future, and addressing wider social issues is inextricably linked with improving patient care.
There is so much to do. As healthcare providers we need to be organised, streamline our systems and rethink our services. Where do we start? We need to utilise remote consultations where appropriate, provide “one stop” clinics rather than multiple appointments and ensure the service we provide is equally accessible for all. We need to respect equality and diversity in our research, our teams and in our day to day practises. The evidence is overwhelming that clinical services are improved by research. Using data to transform the patient journey, finding the correct answers to the questions our patients ask, optimising care. This is also a time for effective leadership to successfully navigate these times of change. We must emerge stronger and more resilient to provide the best service for all who use the NHS.
Rethinking our wider society is also fundamental for improving health. What can we change to make this happen? Better housing, more green space, smarter transport and excellent education would be a great start. Now is our window of opportunity to make the changes required to improve our health. Let’s “see the true state of our condition” and implement positive change to really protect and “value what we enjoy”.
Please note: the details outlined above are not specific to individual patients but give a flavour of the problems encountered by myself and my colleagues during the COVID pandemic. Any resemblance to actual persons is purely coincidental.
1. Scottish Government “Action against inequality” https://www.gov.scot/news/action-against-inequality/
2. Opinion piece from University of Edinburgh https://www.ed.ac.uk/covid-19-response/expert-insights/scotland-can-t-be-complacent-about-covid-s-impact
3. European Commission https://ec.europa.eu/knowledge4policy/publication/socio-economic-vulnerability-epidemic-risk-age-implications-exit-strategy-covid-19_en
4. Public Health Scotland https://www.publichealthscotland.scot
5. Academy of Medical Sciences 2020 Report “Transforming health through innovation: Integrating the NHS and academia” https://acmedsci.ac.uk/publications