Spring 2021 Department of Primary Care & Public Health
touch
mattersCOVID-19, physical examination, and 21st century general practice
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Spring 2021
Many of the articles in this edition of our newsletter discuss Covid-19 vaccination. This is now being rolled out nationally and offers the best way for the United Kingdom to bring the Covid-19 pandemic under control, and allow a return to a more normal way of living. We are very proud that many members of the department, and also many of our medical students, have contributed to the vaccination programme; including working as vaccinators and addressing vaccine hesitancy in marginalised groups. There is also a reminder in the newsletter that Covid-19 is a global pandemic and we won’t be truly safe in the United Kingdom until vaccination programmes have targeted the rest of the world’s population, in Professor Azeem Majeed Head of Department of Primary Care and particular, people in low income countries. Public Health Imperial College London Follow Prof Majeed on Twitter
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Copyright © 2021 Department of Primary Care & Public Health, Imperial College London RETURNING TO PHYSICAL ACTIVITY AFTER A COVID -19 INFECTION
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In an article published in the British Medical Journal, we discuss returning to physical activity after a Covid-19 infection.
A risk-stratification approach can help maximise safety and mitigate risks, and several factors need to be taken into account. First, is the person physically ready to return to activity? In the natural course of Covid-19, deterioration signifying severe infection often occurs at around a week from symptom onset.
Therefore, consensus agreement is that a return to exercise or sporting activity should only occur after an asymptomatic period of at least seven days, and it would be pragmatic to apply this to any strenuous physical activity. English and Scottish Institute of Sport guidance suggests that, before re-initiation of sport for athletes, activities of daily living should be easily achievable and the person able to walk 500 metres on the flat without feeling excessive fatigue or breathlessness. However, we recommend considering the person’s pre-illness baseline, and tailoring guidance accordingly.
PROFESSOR MAJEED AWARDED LEADING HEALTH HONOURS
Six Imperial researchers, including Professor Azeem Majeed, have been appointed to prestigious research positions by the National Institute of Health Research (NIHR).
They have been named as NIHR Senior Investigators – positions given to those who are deemed to be the most outstanding leaders of patient and people-based research within the NIHR faculty. They provide research leadership to the NIHR faculty, promoting clinical and applied research in health and social care. They also act as a key source of advice to the Department of Health and Social Care’s Chief Scientific Adviser. FULL STORY
CONGRATULATIONS PROFESSOR KOSH RAY, YOU'RE A HIGHLY CITED RESEARCHER ─ 2020
Each year, Clarivate™ identifies the world’s most influential researchers ─ the select few who have been most frequently cited by their peers over the last decade. In 2020, fewer than 6,200, or about 0.1%, of the world's researchers, in 21 research fields and across multiple fields, have earned this exclusive distinction.
Prof Ray is among this elite group recognized for his exceptional research influence, demonstrated by the production of multiple highly cited papers that rank in the top 1% by citations for field and year in the Web of Science™.
AWARD FOR BEST PREMATURITY AND NEONATAL RESEARCH - INTERNATIONAL CONFERENCE 2020
Dr Enitan Ogundipe was selected as the ‘Best Neonatal and Prematurity Research with educational grant’ award. The work was on improving the brain outcomes of babies by optimising their mothers’ nutrition in a double blinded placebo- controlled trial. The study was based on work published in Prog Lipid Res 2018 which gave the first ever evidence of effect of maternal ‘Brain Specific’ fatty acid supplementation on their new-born babies’ Brain volumes measured using MRI scan.
ALERT TO SEPSIS WHOCC AND ROYAL COLLEGE OF PHYSICIANS, EDINBURGH Researchers have been awarded JOINT FELLOWSHIP over £800,000 to review the impact of a digital alert system to monitor WHO CC and Royal College of Physicians, patients with sepsis at NHS Edinburgh, have been working on a joint hospitals Quality Governance Fellowship, which will be launched in the latter part of the year. Dr Kate Honeyford (Global Digital Health The fellowship will be based in London, Unit) joined a group of national leaders on and applications will be open in spring. 26 Feb to provide a comprehensive seps More information to be announced on the training day for nurses, paramedics, Centre’s website. doctors and other healthcare professionals. CHILD HEALTH UNIT
CHRISTMAS SOCIAL Kate described the impact of digital sepsis alerts at ICHT, how using data as part of a Child Heath Unit PhD Student, Tishya learning healthcare system can improve Venkatraman, organised a Christmas patient care and described the future Social Bingo for the Child Health Unit work of the DiAlS NIHR project. before the college closure. We saw ugly Christmas jumpers, learnt about each Kate was keen to link robust statistical other’s strange food choices, heard a methodology with improving patient clinician and lecturer sing his favourite outcomes – which meant describing Karaoke song, and guessed each other’s propensity score matching on a Friday and spirit animals. It was a lovely way to afternoon! Although challenging, Kate end a trying year with some fun and gave a clear and erudite description of the laughs. approach. In addition, Kate spoke about the need to appreciate the role, both observational studies and natural experiments, have in our understanding of healthcare provision. Conference delegates described the talk as ‘interesting but very complex and blew my mind a little’, additional comments included ‘so interesting to see how data can be used to benefit quality improvement’ and ‘pertinent to my digital transformation role’. The positive VIVA SUCCESSES response of delegates clearly demonstrates that clear, relevant Congratulations to Shirin Aliabadi and explanations of data and statistics are Federica Amati on passing their vivas. received well by a range of audiences.
My gran has had both her jabs. It’s unlikely that employers could Once lockdown has ended, can I go force you to get vaccinated, but and see her? they could recommend vaccination for staff who have public-facing Once lockdown ends and the roles that place them at increased prohibition on people from different risk of infection. households mixing indoors stops, including for the clinically extremely Everyone in my mum’s care home vulnerable, you would be able to has had the vaccine. Should they visit your grandmother. However, it allow relatives to visit without a may be some time before this screen? happens. Relatives will continue to need to be I’ve been shielding on my own. screened for now because the Once I’ve had the vaccine will I be Covid-19 vaccines are not 100% able to form a bubble with other effective even after two doses and family members? some vaccinated people can still get infected. The risk of serious illness, You would need to continue to complications and death is very high follow any lockdown rules that are in people living in care homes and in place in your local area even after we must be particularly cautious you have had two doses of the with this group. vaccine. Can I still be fined for breaking the I’ve had my first vaccine – can I hug rules if I show my vaccine card? my grandchildren? A vaccine card does not exempt you One vaccination offers only partial from following any local or national protection. Two vaccinations are rules that are in place; so yes, you needed for maximum protection. can be fined for breaking lockdown Even after receiving two doses of rules even if you have proof of vaccine, you would still need to vaccination. follow any lockdown rules that were in place in your local area. Once everyone has been vaccinated, might there be places Can my employer force me to get those who have refused the vaccinated? vaccine aren’t allowed? It’s possible that some places might It will take some time for research implement this policy. For example, to establish this. We may find out some cruise companies have said later in 2021. they will require proof of If one of my employees has been vaccination from customers. vaccinated, should I consider Will I need to show proof of my him/her for a role that has a higher vaccine to travel abroad? risk of infection? It’s possible that some countries will Employers should risk assess staff require proof of vaccination before before placing them in a specific allowing you to travel there but this role. My view is that vaccination will vary from country to country. should not be used as a reason for placing potentially clinically If I’ve had my vaccine will I still vulnerable staff in high-risk roles have to self-isolate if I’ve been in that expose them to a greater risk contact with someone who tested of infection. positive? I’m a piano teacher. Can I advertise If you have been in recent contact for students using my proof of with someone who has tested vaccination to show I’m Covid free? positive, you would still need to self-isolate for 10 days because at Vaccination does not guarantee that this point, we don’t know if you will be “Covid-free”. You would vaccination stops you being need to continue to follow any infectious. lockdown rules that are in place in your local area. When will we know if the vaccine just stops you getting symptoms or stops you getting infected?
Q&As about the AstraZeneca Covid-19 Vaccine Should I really be worried about suffered from blood clots after blood clots? receiving the vaccine but no causal relationship has been found and the The AstraZeneca vaccine has been number of people affected is not given to many millions of people above what we would expect in the across the world (over 10 million in general population in people who the UK). A few of these people have did not receive the vaccine. Image by vecteezy.com How safe is the vaccine? Does your age affect the likelihood of side effects? (For instance, do The clinical trials in which the younger people feel worse because vaccine was tested showed it was their immune systems are better?) very safe, with a very low level of serious side effects and this has Side effects can occur at all ages but been confirmed subsequently in the tend to be less common in older wider use of the vaccine in the UK people. This is thought to be and elsewhere. because the immune system gradually weakens with age, which Why are so many countries also leaves older people more suspending it? susceptible to infection. When a possible side effect is linked Won’t I still be protected if I refuse to a drug or vaccine, some countries the vaccine, because so many other will temporarily suspend use of the people have had it? product until this has been investigated further. This does not It’s important that as many people mean that the vaccine is unsafe and as possible receive the vaccine. If we would expect further review of many people are not vaccinated, we the data to confirm its safety. will continue to see outbreaks of Covid-19. The vaccine is not 100% Can I reduce the risk of a blood clot effective and children are not by taking an aspirin? currently being immunised, so there It’s probably not advisable to use will be many people who can still aspirin in this way athere is a small become infected. risk of suffering a serious stomach What’s the down side of not having bleed after taking aspirin. the vaccine? What are the other possible side If you don’t receive the vaccine, you effects of the vaccine? are at much higher risk of The most common side effects of contracting a Covid-19 infection. the vaccine are pain and tenderness These infections can be serious, at the injection site, headache, leading to long-term complications tiredness, generalised muscle pain, and death in many people. You may shivering and a fever. These side also infect others, including elderly effects usually resolve within a few relatives who may be at high-risk of days. serious illness. Furthermore, the more people who receive the vaccine, the more likely we are to an end to the pandemic and the lockdown measures it has led to.
In an article published in the Daily Mirror, Matt Roper and Prof Azeem Majeed debunk some of the common myths and misconceptions about vaccines. Scepticism about vaccines has been growing throughout the pandemic and a recent survey found that one in five British adults may refuse to take a coronavirus jab – even though it is probably our only hope of a return to normality.
1. MYTH: A vaccine produced Azeem Majeed is professor of so quickly can’t be safe primary care and public health at Imperial College London Most vaccines take years to develop, test and approve for public “Allergies to vaccines are very rare,” use but, says Dr Majeed, a global says Dr Majeed. “They are given effort has meant scientists have safely to millions of people every been able to work at record speed. year.” He says: “Covid-19 vaccines have to The odds you’ll have a severe go through the same process of reaction to a vaccine is about one in approval as other vaccines. Funding 760,000. was made available immediately Being struck by lightning next year is and studies set up rapidly. higher at one in 700,000. “There have been a lot of Most reactions are because of some technological developments that other component of the vaccine, allow vaccines to be developed such as egg protein, if the person is much more quickly.” severely allergic. 2. MYTH: I might be allergic but 3. MYTH: There haven’t been won’t know until I get it enough tests for people with underlying conditions Dr Majeed says: “There are many contain a live coronavirus,” assures vaccine trials taking place and they Dr Majeed, “and they therefore are being tested in people with can’t give you a coronavirus different characteristics, such as infection”. age, sex, ethnicity and medical 6. MYTH: If everyone around history. me is immune, I don’t need a “Results show they are safe in all vaccine groups they have been tested in.” “It’s essential to achieve a high 4. MYTH: Vaccines can overload vaccine coverage so we create herd your immune system immunity,” says Dr Majeed. “If people refuse to be immunised, we In 2018 the myth was debunked by will continue to get outbreaks of American researchers who Covid-19. examined the medical records of more than 900 infants from six “If you decline to be immunised, hospitals. you may get infected and also infect the people you come into contact They found no link between with.” vaccines given before the age of two and other infections in the 7. MYTH: It’s better to be following years. immunised by catching Covid “Vaccines do not overload your Dr Majeed says: “Vaccines have immune system,” says Dr Majeed. been shown to be very safe, “On the contrary, they generate an whereas illnesses such as measles immune response that helps reduce and Covid-19 can lead to serious the risk of infection, complications long-term medical complications. and death.” “Vaccines have saved many lives 5. MYTH: The vaccine could and prevented people from being actually give me coronavirus left disabled.” Some vaccines contain the germs 8. MYTH: Vaccinated children that cause the disease they are experience more allergic, immunising against, but they have autoimmune and respiratory been killed or weakened to the diseases point they don’t make you sick. This is another unfounded claim In the case of a coronavirus vaccine, that has led some parents to delay “none that are in development or withhold vaccinations, says Dr syndrome, a rare neurological Majeed. disorder. Studies examining many vaccines Dr Majeed says: “Covid-19 vaccines have failed to find a link with have been carefully tested in a large allergies or autoimmune disease. number of volunteers and found to be very safe. “Vaccines protect against many diseases and substantially reduce 11.MYTH: Vaccines cause the risk of illness and death in autism children,” he says. The idea that vaccines cause autism 9. MYTH: Some of those taking has long been disproved but the part in trials died claims have recently been doing the rounds again. Stories that Dr Elisa Granato, one of the first participants in the human Last year a massive study from trials of the Oxford vaccine, died Denmark found no association shortly after being injected, were between being vaccinated against shared millions of times. measles, mumps and rubella, and developing autism. The news was false, and she gave a BBC interview saying she was It is the latest of at least 12 other feeling “absolutely fine”. studies that have tried and failed to find a link. “Only one death has been reported among people taking part in trials,” Dr Majeed says: “No evidence has says Dr Majeed. ever been found that vaccines cause autism in children.” João Pedro Feitosa, a doctor in Brazil, was given the placebo rather 12.MYTH: The Spanish Flu than the vaccine and died of Covid- vaccine led to 50 million related complications. deaths 10.MYTH: The swine flu vaccine During the 1918 pandemic, it was left people with side effects, the fact there was no vaccine, that so why would this one be caused it to infect a third of the safe? world’s population. A mass vaccination programme In the 1930s scientists found it was against swine flu in the US in 1976 caused by a virus, with the first led to increased chances of people vaccine developed a decade later. developing Guillain-Barre
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Image by jcomp via freepik.com
touch
matters COVID-19, physical examination,
and 21st century general practice By Paquita de Zulueta
The pandemic, not yet over, has already significantly changed how primary care functions. GPs, typically innovative and adaptable, swiftly switched to ‘remote’ consulting in March, with telephone and video consultations the norm and face-to-face the exception, albeit still available. GP’s express concerns that the ‘flight to the virtual’ may lead to losses, including the sapping of energy and joy and an increase in health inequalities. But there is another deeper issue at stake. The loss of touch in our personal encounters threatens the wellbeing of all of us and, in particular, for those who are vulnerable and living alone. In the context of our professional encounters, the physical examination, aside from its diagnostic value, is an important mode of communication and a skill that requires embodied learning and practice — ‘body pedagogics’. We should be wary of discounting its value. HUMAN SKIN AND THE ‘MAGIC’ OF TOUCH
Giles Dawnay in the BJGP posed the calming us by activating the question: ‘Could our skin be far more than parasympathetic system, releasing just a barrier to the elements?’ My oxytocin, serotonin, and endogenous answer is a definite ‘yes’. Ashley Montagu, opioids, thus additionally acting as an in his seminal book reminds us that the anaesthetic. Touch enhances cooperation skin ‘is the oldest and the most sensitive and trust. of our organs, our first medium of communication and our most efficient And yet, despite this rich evidence from a protector.’ The largest and most versatile variety of disciplines, touch is poorly of our sense organs, it holds an researched in the medical field and astonishing number of sensory receptors curiously lacking in medical and bioethical for heat, cold, touch, and pain, giving us discourse. an integrated sense of our bodies. When we are stressed and feeling Montagu claims that touch is more vulnerable, we long for and need kind, powerful than language and central to human touch. This is why the ‘social human life, providing us with our most distancing’ imposed by this pandemic is so fundamental means of contact with the cruel and dehumanising for all of us, but external world. Research indeed confirms particularly for those who live alone, for that the skin is a social organ, coding the vulnerable, the sick, the bereaved, the interpersonal interactions and enabling us dying, for caregivers who are denied to develop our sense of ‘felt security’ and access to their loved ones, and for connectedness. Touch communicates healthcare professionals looking after emotion in a ‘robust fashion’ and people patients with COVID-19 who fear to touch can discern with a high degree of accuracy their partners and children when they go anger, fear, sadness, and disgust, as well home. as happiness, gratitude, sympathy, and love. Research shows that touch — in We have all read or heard the harrowing particular, affectionate touch — is also stories from caregivers and from those key to relational, physical, and who have lost their loved ones in COVID- psychological wellbeing in adults. 19 times. Affectionate touch buffers one to stress,
THE PHYSICAL EXAMINATION
Abraham Verghese and Ralph I Horwitz have made a passionate call for the reinstatement of the physical examination, arguing that it not only avoids unnecessary tests but also helps to develop trust, empathy, and relationship building.
In my 35 years as a GP I have been surprised by the revelations that have
Dr Paquita de Zulueta Image: rawpixel.com via freepik.com
flowed from the many physical humane and authentic conversation than examinations. This practice has often felt peering at a blood test or X-ray results on as an almost sacred ritual eliciting trust a computer screen. This is not to and information that bypasses the verbal disparage the usefulness of test results or and visual. Yes, there were the diagnostic the telephone consultation and surprises — the unexpected lump, the telemedicine. They may well be lifesaving hidden bruises or scars, the unsuspected in some circumstances and do offer breech, or perhaps a ‘secret’ tattoo or convenience, although not necessarily body-piercing. But often the revelations speed. were stories of pain and suffering — sexual assault in childhood, torture in Visiting the frail elderly when working for another country, a coercive or illicit the emergency service, I was struck by relationship, an unmourned bereavement, their anguished loneliness. Yes, the carer hidden fears. And as I percussed the had filled the dosset box, and checked chest, or palpated the abdomen, or even that they had ‘taken their meds’ and had undertook an intimate examination, I eaten (maybe), but what seemed to give would hear ‘I have never told anyone them solace, to elicit a tentative smile or about this, doctor.’ Touch became a door even tears of relief, was when I held their to a hereto undisclosed inner world. hands, gnarled and trembling, in a firm, warm clasp. They longed to have a chat, I use the examination to further the to reminisce, to share a cup of tea. I would dialogue, to hear more about people’s try to bring some humanity to the lives, who they are, what they do, their encounter, but time pressures limited the family, their hobbies. And this dialogue is scope for this. conducted at two complementary levels — with our speech and our bodies. The Phenomenology — a philosophy of intimacy of contact encourages a more embodiment in which mind and body are inseparable — offers us rich insights into touch. Maurice Merleau-Ponty reminds us In the intimacy of the physical that the lived body is reversible or examination we, as both patients and ‘double-sided’ in that it is both an clinicians, render ourselves more open, experiencing subject and a material object more vulnerable. The etymology of the in the world. This ‘dual existence’ as both word is relevant: the Latin intimus consciousness and physical matter is signifying ‘innermost’, and intimare to probably unique to humans. Touch brings ‘impress’, or ‘make familiar’. us in contact with others, but also with our own embodiment. When carrying out The avoidance of touch may be linked to a physical examination we are observers the understandable fear of being seen as and examiners, but also subjects who are invasive, of transgressing boundaries, or responding to our patients’ responses and even being accused of sexual molestation perceptions of us. It is a form of dynamic — but is there also an unspoken fear of dialogue and we oscillate between our engagement, of getting ‘too close’ to our subjectivity and objectivity. patients, of being ‘touched’ by their suffering?
A TYPOLOGY OF TOUCH
Touch can help us as clinicians to discern, bodies. Leder describes how those in the detect, and diagnose, but can also allow ‘kingdom of the sick’ yearn for the caring us to express empathy, reassurance, touch: ‘Ultimately, healing touch is not comfort, and presence. A study of GP’s something the clinician does or the and patients’ perceptions regarding touch patient. Touch unfolds in the reciprocal revealed that all patients and most space between the I-Thou relationship.’ doctors believed that ‘expressive touch’ This reciprocal touch is described in the improved communication. literature as ‘relational’, ‘empathic‘, ‘compassionate’, or ‘caring’. ‘Healing touch’ has a long history dating from classical times with the myth of From my lived experience as both patient Asclepius, the Greek god of medicine. and doctor, I believe it is possible to use Drew Leder describes the impersonal both kinds of touch concurrently — a ‘objectifying touch’, and the ‘absent ‘compassionate objectivity’. A study with touch’ when technology displaces human- Canadian family doctors appears to to-human interaction. Objectifying touch confirm this: the GP’s viewed the physical — also described as ‘procedural’ or examination as practising good medicine ‘instrumental’ — is necessary, but if and that the ‘gnostic’ (intellectual, unaccompanied by any form of empathy objective) elements were inextricably or reciprocation can leave patients feeling linked to the ‘pathic’.14 bereft and alienated from their own
CONCLUSION
We are embodied social beings. We thrive key part of those relationships in everyday on nurturing relationships. Touch forms a life but is also a powerful form of communication for clinicians, allowing for ‘Losing touch’ threatens to undermine our wordless dialogue, presence, and relationships with our patients, our embodied empathy. ‘Touch hunger’, a professional practice, and a key element term coined by Tiffany Field, threatens of our pedagogy. Clearly we are still in the our sense of being-in-the-world, our midst of the pandemic and difficult connectedness, growth, and flourishing. balancing acts are being made on a daily This has been greatly exacerbated by the basis between avoiding potentially pandemic-driven ‘social distancing’. Yet harmful, or even lethal, contagion and the drive for a ‘contactless’ world had avoiding harm to social bonds and been gathering pace well before the livelihoods (blandly called ‘the economy’). pandemic. Our tactile poverty has been My fervent hope is that once we are ‘safe’ intensifying with the digitalisation of our again, the profession recognises the lives and pervasive technophilia. Remote importance of touch in its healing consultations may be seen as repertoire and pedagogy, and does not advantageous: no risky physical eschew the physical examination as an interactions, more efficient, more integral part of practice. convenient. The physical examination should remain a ‘touchstone’ of general practice.
This article is reproduced with kind permission from British Journal of General Practice - Life
Image: Sarah Richter art
Perspectives of GP Heads of Teaching on cultural diversity and inclusion in undergraduate primary care
Imperial’s Medical Education Innovation and Research Centre (MEdIC) are currently involved in an exciting new collaborative qualitative study with researchers from the University of Dundee and the University of Glasgow. The study aims to explore and understand the perspectives of UK GP Heads of Teaching on cultural diversity and inclusion in medical education. In December 2020 five focus groups were conducted with 23 GP Heads of Teaching from across UK medical schools. Participants explored opportunities and barriers to cultural diversity and inclusion, discussed strategies to overcome to these challenges, and shared examples of best practice.
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The data is currently being thematically analysed by three researchers, and early results show there are both opportunities and challenges integrating diversity and inclusion within medical education at student, educator, and institutional levels. Deep structural inequities continue to exist in medical education, and medical schools must work collaboratively with faculty, students and other institutions, to strive to progress forwards with visible and sustainable change.
This piece of work fits within MEdIC’s innovation and research theme on Diversity and Inclusion and links to the national working group MEdIC founded on Diversity and Inclusion in Medical Education.
Image: rawpixel.com via freepik.com In January 2021, building on our relationships with local schools, Undergraduate
Primary Care
Education launched an exciting and innovative new module for year 2
Imperial Medical and
Biomedical science students called I-
Explore: Social Accountability in
Action. This module was developed by our
Community
Collaboration Lead, Bethany Golding, together with Josh Gaon, Neha Ahuja,
Arti Maini and
Imperial StudentShapers
Huriye Korkmazhan, Nadia Zaman & Ray
Wang, with input from local schools and community partners. Imperial students explore the Council, Mosaic Trust and Young concepts of social accountability, Hammersmith and Fulham Foundation. power and privilege through a real- We have been grateful to receive world project developing and valuable input throughout from delivering after-school STEMM-based Matthew Chisambi, a TeachFirst sessions for local secondary school Ambassador, and the Innovation Lead pupils in partnership with at Imperial College Health Partners. schoolteachers. STEMM topics have included a focus on the COVID-19 A key challenge this year has been the pandemic context, including topical need to run the entire module, issues relating to vaccine hesitancy including delivery of after-school and equitable distribution of the sessions, virtually. As many will know, vaccine. running an interactive session virtually can be tricky even for the most Imperial students have worked closely experienced of teachers. Our Imperial with the participating schools in students rose to this challenge, Hammersmith and Fulham (Fulham creating engaging and inclusive Cross Academy, Phoenix Academy and material that brought their sessions to Hammersmith Academy) to ensure the life. sessions are engaging, inclusive and relatable for the pupils. Through this The feedback from schools has been fantastic so far. real-life project work, our Imperial students are gaining invaluable A presentation event in March was the experience of working in partnership culmination of the project, where the with schools and with young people students showcased their work as well from a wide range of backgrounds and as reflections and lessons learnt from abilities as well as applying critical their teaching experience. enquiry, creative thinking and using problem solving skills. Although the pandemic has presented us with many unforeseeable To support this experience, we challenges, we have been encouraged provided central sessions where and heartened by the ability of our Imperial students learnt core inclusive students, faculty team, schools and teaching skills and were supported to pupils, to navigate rapidly changing explore concepts of social circumstances, and by the feedback we accountability, including consideration have received. We hope that I-Explore: of power and privilege, and reflect on Social Accountability in Action provides how these principles relate to their an exciting example of how our faculty future professional career and their and students can work in partnership- role in society. These sessions were with local schools and communities to built using inclusive material inspire our future generation, and we developed in collaboration with the very much look forward to building on three participating schools, and with this work. Hammersmith and Fulham Youth
Feedback from a teacher at Hammersmith Academy:
“I just wanted to pass on my gratitude on behalf of our pupils for the sessions yesterday, and my praise for the Imperial College students who led them so well. They were both fantastic sessions and flowed very well, stimulating sophisticated, thought-provoking conversation. The information shared was relevant and accessible to our students and the guidance they gave in regard to higher education was most definitely inspiring. I have no doubt that our pupils left the calls, considering their potential and excited for the future”
EFFECTIVENESS OF MENTAL HEALTH WORKERS COLOCATED WITHIN
PRIMARY CARE
Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. In a paper published in the journal BMJ Open , we reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.
Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. The interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.
We concluded that while there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.
Image by Tumisu from Pixabay NEW RESEARCH
Image by Adele Morris from Pixabay
We would like to congratulate Clinical Senior Lecturer, Cheryl Battersby (pictured below), on successfully gaining a 5-year NIHR Advanced Fellowship, entitled neoWONDER: Neonatal Whole population data linkage to improve lifelong health and wellbeing of preterm babies. Cheryl’s cycle. These babies require research will specialised care in neonatal units. At link the present, we do not fully understand National the longer-term impact of neonatal Neonatal care and interventions (like feeding Research and breathing support) or of social Database and environmental factors following (Utilising the hospital discharge. Therefore, a National Neonatal Research better understanding of the longer- Database | Faculty of Medicine | term impact would help improve Imperial College London) to other neonatal care. However, this health and education data to requires following up these understand and improve the longer- children’s development, which can term outcomes of babies born very be complex and costly. Finally, prematurely. This final linked bringing together existing routine dataset will include data for over data will help us understand how 100,000 babies born over the last these babies progress through their 14 years in England and Wales. childhood. As a result, we could learn what neonatal unit Each year in the United Kingdom interventions and/or post-hospital around 8,000 babies are born social/environmental factors, may prematurely less than 32 weeks of have impacted on their the normal 40-week pregnancy development. Please visit the study website if you would like to find out more about neoWONDER.
Image: Covid-19 by Richard Huňis – Public Domain
The Year 3 Medicine in the Community Apprenticeship (MICA) provides undergraduate medical students with an opportunity to do an 8-week placement in primary care. During this placement students are asked to work in pairs to develop a Community Action Project (CAP).
The CAP is a collaborative community-based quality improvement project where students are encouraged to think about issues affecting the local communities in which they are placed and design a project to address these. They are encouraged to work with the practice, community groups and patients. During Term 2, students were asked to focus on COVID-19 and the health and wellbeing priorities that have arisen due to the pandemic. The COVID-19 vaccine, including addressing local vaccine hesitancy was highlighted as a particular priority area.
In the final week of their placement, students of the projects was excellent with students presented their projects in small groups and addressing vital local issues using a range of received feedback from their peers and innovative methods. primary care department tutors. The quality
Some particular project highlights from this term include:
• Nabeeah Ahmed and Jiwon Seo conducted a project aiming to explain COVID-19 to children. The students sent a survey to local primary schools to identify the local need and reviewed existing COVID-19 information resources aimed at children. They used this information to create a storyboard and video entitled ‘The Story of Mo and Coco’ (storyboard on opposite page), which aims to explain COVID-19 to 4-7-year-olds. These resources were then disseminated to local children and parents. Students received positive feedback on the intervention via a survey by over 50 parents. The video is available for children and parents to access on the GP practice website and has been sent to a local primary school. The GP team are hoping to distribute the resources more widely to other practices.
• Ailin Anto and Arunima Basu explored COVID-19 vaccine hesitancy amongst care home staff. The students initially identified low uptake of the COVID-19 vaccine amongst staff at a local care home. They then asked care home staff to complete a survey exploring their vaccine concerns and met with the local Clinical Commissioning Group (CCG) to ascertain their understanding surrounding local vaccine hesitancy. The students created two videos aiming to increase vaccine uptake, which were shared with local GP practices, the CCG, Primary Care Network (PCN), the local council, the local authority, and an interfaith charity. Many of these organisations have placed the videos on their websites, shared them on social media, or disseminated to care homes and care providers. One video addressed the main concerns identified from their analysis using animation, and the second interviewed local community members who discussed their experiences of having the vaccine. In addition, the students conducted webinars with two local care homes showcasing the videos and discussing their personal experiences of receiving the vaccine. The videos and webinars were evaluated positively, particularly for the diversity of community members within the videos, and increased likelihood of vaccine uptake by participants was reported. The students plan to adapt the video with subtitles in different languages and disseminate more widely via other PCNs.
As these projects demonstrate, the students currently analysing the projects to share worked collaboratively with community important findings and innovations with the partners and engaged meaningfully with the Department of Health and Social Care. community in their local area to positively Research is also being undertaken to ascertain impact upon health and wellbeing in student learning experiences from the innovative ways. The Medical Education projects. Innovation and Research Centre (MEdIC) are
Image: freepik.com
A PICTURE OF HEALTH
By Sophie Coronini-Cronberg
The COVID-19 outbreak has shone an
unequivocal light on some of the stark
inequalities in health and life chances
people are living with every day,
including the increase in domestic
abuse reports, or children struggling
to access home-schooling.
The challenge in starting to address inequalities is we need to understand the local population’s demographic profile, along with their key health needs. While public health information is routinely published for organisations such as local boroughs, the same data does not exist for hospitals.
In large cities like London, there are 620,000 people, or 1 in 14 of London’s multiple hospitals, local boroughs, primary population, who fall within the Trust’s care providers and networks, and core catchment in two large areas, each integrated care systems. Coupled with a broadly centred around one of the Trust’s highly mobile population, this makes sites, West Middlesex University Hospital, defining a hospital’s local population and Chelsea and Westminster Hospital. It extremely difficult: simply describing the shows the catchment encompasses highly attending population misses those who deprived and affluent areas, and an cannot access services, do so elsewhere, ethnically diverse population. The or are currently well. Yet, it is precisely population is also relatively young this denominator that is critical to compared to England as a whole with 2 in measuring equitable population health 3 (69%) aged 15 to 64 years. outcomes. A key public health concern is the impact To try to address this, the Trust and that health inequalities, such as those Imperial College collaborated to model associated with deprivation, disability and and define a core catchment area; this ethnicity, are having on the lives of local represents the area from which a people. We found significant variation in significant proportion of people requiring health needs across our local community: hospital treatment will access one of the people living in the most deprived parts of Trust’s two hospitals. The work was in the catchment live at least 20 fewer years part supported by a Health Foundation in good health than those in the most grant. affluent areas
The model defines where people are most This work gives us a new perspective on likely to come from if they need hospital the population that we serve. By care and in turn allows us to describe the developing a better understanding of the population’s size, geographical reach and local community that is likely to use one basic demographic profile. Then of our hospitals, rather than just those overlaying open-access datasets allows us who actually attend, we can make better to estimate social and health indicators. decisions about how we plan and deliver This starts to tell the story about the services, including COVID recovery, as well community the Trust serves and helps as how we support local preventative shine a light on potential priority areas for efforts to keep people healthier for improving health and wellbeing, including longer. through equitable access to services, health outcomes and employment. The modelling was complemented by a qualitative assessment consisting of key In September, the Trust published its first stakeholder interviews to explore the public health needs assessment of its core model’s utility in supporting service design population. The report identifies around and delivery. This has given us insight into
potential areas of future focus. The trust is reached out and expressed interest in also exploring applying outputs from this learning about and/or replicating this work to support geographical model. Perhaps most notably, NHS prioritisation of preventive outreach Providers have recently cited it as a ‘best options and service integration, as well as practice case study’ in a framework proportional resourcing for hospital-based document outlining the NHS should be public health interventions such as alcohol addressing health inequalities during harm reduction. COVID and beyond. Also, in March, it was announced that the project has been Since the publication of A Picture of shortlisted for an HSJ Value Award 2021 in Health, a range of acute trusts, national the ‘Value Pilot Project of the Year’ and also third sector organisations have category.
Sophie Coronini-Cronberg is a Consultant in Public Health at Chelsea and Westminster NHS Foundation Trust, Honorary Senior Lecturer at Imperial College London, and Implementation Lead for NIHR ARC NWL.
For further information, please contact any of the following: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]
Image: Our Core Catchment area –Chelsea and Westminster NHS Foundation Trust
Image: freepik.com
DEMOCRATISING SELF-CARE WITH ONLINE SYMPTOM CHECKERS
Online symptom checkers are becoming increasingly sophisticated and could help individuals with a health concern get a consultation outcome and a triage recommendation online. Once a consultation outcome is made, the end-user can learn more about the condition they may have to determine the best course of action.
As online symptom checkers become more sophisticated, they will become more accurate at predicting the correct consultation outcome and can help the end-user determine if they need to see a GP, seek emergency care or simply self-care. An emerging and key benefit of these online tools is to promote an individual’s self-care capability for common and everyday conditions and ailments. This could be done by signposting individuals to relevant and quality assured self-care guidelines to promote self-care for specific self-treatable conditions. The widespread use of online symptom checkers can help promote health literacy levels and can even save precious NHS resources by promoting self-care for common conditions in the community setting where otherwise the end-user may book a GP appointment to get support.
There are numerous free online consultation checkers currently available but no definitive way to benchmark their performance. To address this gap, Imperial College London Self-Care Academic Research Unit (SCARU) is collaborating with RCGP and Healthily on a study to assess the suitability of benchmarking the performance of online symptom checkers using a series of primary care vignettes. We are also conducting a systematic review on the safety and clinical accuracy of online symptom checkers. This would complement our ongoing qualitative research to understand extant barriers and drivers for the routine diffusion and adoption of online symptom checkers by members of the public and the impact this could have on health systems worldwide.
We hope that this work will raise the profile of online symptom checkers as a key tool that can help democratise self-care in the new setting.
Image by rawpixel.com
Our new paper published in the Journal of the Royal Society of
Medicine discusses whether the government should take ethnicity into account when establishing priority groups for Covid-19 vaccination as one component of a strategy to target health inequalities. COVID-19 has disproportionately affected Black, Asian and Minority Ethnic (BAME) groups, resulting in higher rates of infection, hospitalisation and death. The COVID- 19 pandemic has also exposed the pre-existing racial and socioeconomic inequalities in the UK. However, the Joint Committee on Vaccination and Immunisation has omitted ethnic minorities from the top priority groups which include older age, frontline health and social care workers, and care home staff and residents. The invisibility of these vulnerable groups from the priority list and the worsening healthcare inequities and inequalities are putting ethnic minorities at a significantly higher risk of COVID-19 illness and death.
The UK’s vaccine allocation strategies devastating impact lasting far beyond have the potential to further the end of the pandemic. exacerbate the pre-existing, persistent Controlling further outbreaks and, but avoidable, racial inequalities that ultimately, ending the pandemic will the COVID-19 pandemic and the wider require implementation of approaches governmental and societal response that target ethnic minorities as well as have harshly exposed and amplified. ensuring that vaccine allocation Dismissing the racial and strategies are effective, fair and socioeconomic disadvantages that justifiable for all. ethnic groups face may result in a
Covid-19 vaccine hesitancy among ethnic minority groups
In an editorial published in the British Medical Journal, we discuss the highly topical issue of Covid-19 vaccine hesitancy among ethnic minority groups. With mass Covid-19 vaccination efforts under way in many countries, including the UK, we need to understand and redress the disparities in its uptake. Data to 14 February 2021 show that over 90% of adults in Britain have received or would be likely to accept the Covid-19 vaccine if offered. However, surveys have indicated much greater vaccine hesitancy among people from some ethnic minorities. In a UK survey in December 2020, vaccine hesitancy was highest among black, Bangladeshi, and Pakistani groups compared with people from a white ethnic background.
The legitimate concerns and yet to make up their minds about the information needs of ethnic minority vaccine. Covid-19 vaccination is one of communities must not be ignored, or the most important public health worse still, labelled as “irrational” or programmes in the history of the NHS. “conspiracy theories”. We need to Tackling vaccine hesitancy and engage, listen with respect, ensuring that vaccination coverage is communicate effectively, and offer high enough to lead to herd immunity practical support to those who have are essential for its success.
Image by Tumisu from Pixabay
The 2020/21 Widening Access To Careers in Community Healthcare (WATCCH) programme came to a close in February. WATCCH is a widening participation initiative for Year 13 students interested in pursuing a healthcare career. The 2020/21 programme consisted of a series of remote workshops, developed and run by Imperial medical students on the WATCCH committee, and the primary care team. The workshops are supported by medical student mentors recruited by Vision society.
The programme covers varied topics large and small group sessions, as well as including interview skills, personal a truly insightful talk from a first year statement writing and reflection and Imperial medical student on her coaching. The WATCCH students also have experience of starting university during the opportunity to participate in a the COVID-19 pandemic. question and answer workshop with multi-disciplinary healthcare professionals Over the next few months, whilst students and attend mock interviews. For the final are awaiting interviews and university workshop students were given the offers, they can continue to access opportunity to suggest topics they would support from their Imperial medical like to cover. In response to their student mentors via Brightside, an online suggestions the WATCCH team developed mentoring platform. The WATCCH team a ‘Higher Education Tips’ session covering are currently planning for the programme key concerns such as finances, academic in 2021/22 where we hope to be able to study tips, university support services, and re-introduce primary care work the effect of the COVID-19 pandemic on experience opportunities. university life. The workshop consisted of
Cat Jackson on a
mission to run 60km in 6 weeks, to raise money for Leukaemia UK
Cat Jackson, NIHR School for Public Health Research Coordinator, set herself a challenge to run 60km over 6 weeks, in order to raise money for Leukaemia UK. The charity was particularly pertinent to Cat as she lost her mum, Pauline Coulton (pictured), to Leukaemia in 1989 when she was 4. Tragically her mum was just 27 when she died, after battling against the disease for more than two years. This year marks what would have been Pauline’s special 60th birthday, and although the family haven’t been able to celebrate her birthday in the traditional way, Cat decided raising money for Leukaemia UK, was a fitting way to honour her memory. Between February and March, Cat ran 60km, a 10km run every weekend, until her mum’s birthday on Saturday 20th March.
Unless you have been directly affected by Leukaemia, you may not be greatly aware of it. It is a type of blood cancer and someone in the UK is diagnosed with blood cancer every 16 minutes. Cat has raised money not only to celebrate her mum's life, but also to make a small difference in the fight against Leukaemia. Treatment options were quite limited back in the 1980s when Pauline was suffering with Leukaemia, but research advancements are taking place all the time, and it is vital even during these challenging times that this research continues.
Many charities and families are struggling financially at the moment, due to the knock-on effect of COVID, but support in any way has been very much appreciated, whether that was raising awareness of the disease, helping to spread the word about the fund-raising effort, donating or simply following Cat’s journey on social media! Leukaemia UK have set up a designated fund raising page, and Cat has setup the Instagram page, mumrun60, logging her training progress, which includes profiles of her weekly running buddy’s and coverage of the big runs each week.
SELF -CARE SAFARI: POLICY MAPPING EXERCISE
The WHO published the Consolidated Guideline on Self-Care Interventions for Sexual & Reproductive Health & Rights (SRHR) in June 2019. The guideline consists of 24 recommendations split across 4 categories: (1) improving antenatal, delivery, postpartum & new-born care , (2) providing high quality services for family planning, including infertility services, (3) eliminating unsafe abortion, and (4) combating sexually transmitted infections including HIV and other gynaecological morbidities.
Two years on, and there is considerable interest to determine the extent that these recommendations are being implemented around the world. To this end, Imperial College London Self-Care Academic Research Unit (SCARU) is collaborating with Population Services International to conduct a policy mapping exercise in Kenya, Nigeria & Uganda.
As there is no precedent for this, SCARU developed a mixed methods research approach to conduct the policy mapping exercise. The methodology includes desktop research to identify national policy documents, white papers and peer-reviewed studies relevant to the WHO Guideline, and primary data collection from a wide mix of stakeholders using an online tool (electronic survey) and personal interviews with key informants in each country.
This baseline policy mapping exercise would signal the first step to objectively assess how each country is aligning with each of the 24 recommendations and lessons learnt would help inform the development of future policy mapping exercises earmarked for Senegal and other francophone countries in Sub-Saharan Africa. The work can also help inform country-specific advocacy tools for the consideration of policy makers.
The WHO is currently finalising Supplement to the Self-Care Guideline. Austen El-Osta (SCARU) is a member of the WHO External Review Group and has built capacity in the Unit to help raise more awareness about the WHO Guideline on Self-Care Interventions and the formative Supplement earmarked for publication later this year.
Image: rawpixel.com – creative commons
Image: Alfonso Cerezo from Pixabay
MEASURING
THE
LONG-TERM
SAFETY
AND
EFFICACY
OF
COVID-19
VACCINES
There is a need for accurate recording of any adverse events following administration of Covid- 19 vaccines. As these vaccines are new, we don’t yet have long-term data on their safety and efficacy.
This data is essential to help build public confidence in these vaccines and ensure take-up of the vaccines is high; not just in the UK but globally as well. The data will also help identify how frequently vaccination is needed to ensure vaccine recipients retain their immunity to Covid-19.
The UK is well-placed to collect this The use of this data will be data. We have a National Health facilitated by the recently Service that has developed developed clinical codes for Covid- computerised medical records for 19 vaccines for recording use in general practices on a information in electronic medical population of around 67 million records. These codes include, for people. These electronic medical example, codes for whether people records provide longitudinal data on attended or did not attend for their people’s health and medical vaccination appointment; whether experiences. They can now also be they declined to be vaccinated; and linked to other data; such as whether they had a clinical contra- hospital admissions records and indication to being vaccinated. mortality records, as well as to the Other codes allow recording of the results of Covid-19 tests, increasing specific vaccine that was their value for monitoring the safety administered, which will be and efficacy of the new Covid-19 essential for comparing the long- vaccines. term safety and efficacy of different Covid-19 vaccines. The comprehensive nature of these medical records and the large The data from electronic medical population they cover means that records can be supplemented by they can be used to look at safety the reporting of any suspected and efficacy of Covid-19 vaccines in adverse events by health specific populations. This could be, professionals to the MHRA via the for example, by age, sex, medical Yellow Card Scheme. Vaccine history or ethnic group. It would recipients should also be also be possible to look at more encouraged to report any reactions serious health outcomes and death directly to the MHRA a well as to rates by linkage to other data sets. their doctor. This allows the MHRA Hence, planning how we would use to build up information on the these data is essential and needs to safety profile of the new Covid-19 start now. vaccines and advise patients and the public of any potential problems.
Image: Alfonso Cerezo from Pixabay PRESCHOOL WHEEZE PARENT GROUP: PUBLIC AND PATIENT INVOLVEMENT
We are researching
pre -school wheeze (1-5 years) and wanted to
hear parents’ or carers’
experiences of visiting the doctors or hospital emergency department. Across four virtual sessions in
March, parents and carers had the
opportunity to share
their experiences. Discussions involved communication and support in healthcare settings and access to
healthcare during the Covid-19 pandemic.
Parent involvement has
helped shape our research, providing insights from a parent’s perspective. This follows our editorial , ‘Primary care of children and young people with asthma
during the Covid-19 era’, being cited in the
updated British
Thoracic Society on asthma management during the Covid-19 pandemic.
CURBING THE SPREAD OF COVID-19 IN LOW INCOME COUNTRIES
Globalisation impacts the epidemiology of communicable diseases, threatening human health and survival globally. The ability of coronaviruses to spread, quickly and quietly, was exhibited with Severe Acute Respiratory Syndrome in 2002–2003 and, more recently, with COVID-19. Not sparing any continent, the World Health Organization declared a COVID-19 pandemic on 11 March 2020. In an article published in the Journal of Royal Society of Medicine, we discussed how higher income countries can support the response to Covid-19 in low income countries. Despite high-income countries mortality and economic being inordinately impacted, due to devastation, these discussions have the increasing number of COVID-19 not involved low- and middle- cases, SARS-CoV-2 continues to income countries. COVID-19 may represent a looming threat to the cause unprecedented humanitarian Global South, leading the World health needs in countries already Health Organization to previously subjected to unaffordable, state that ‘Our biggest concern fragmented and fragile health continues to be the potential for systems; as COVID-19 unfolds a COVID-19 to spread in countries worldwide economic crisis, with the with weaker health systems’ and poor and other vulnerable groups that Africa could become the next affected disproportionately, epicentre. building health system resilience, through an urgent and coordinated However, while academics, public global response, that allocates health experts and resources and funds efficiently, macroeconomists discuss among must be prioritised in this dynamic themselves, using collaborative and shifting pandemic. strategies to reduce morbidity,
Image: AMISOM Public Information via flickr - Public Domain RESEARCH
Photo: Moderate non-proliferative diabetic retinopathy by K Viswanath Published in: Community Eye Health Journal Vol. 16 No. 46 2003
Creative Commons via FLICKR
ASSOCIATIONS BETWEEN ATTAINMENT OF INCENTIVIZED PRIMARY CARE INDICATORS AND INCIDENT SIGHT‐ THREATENING DIABETIC RETINOPATHY
Our new study published in the journal Diabetes, Obesity and Metabolism shows a lower incidence of sight‐threatening diabetic retinopathy in people with type 2 diabetes who meet QOF targets for HBA1c, blood pressure and lipid control.
We aimed to examine the impact of neighbour propensity score attainment of primary care diabetes matching was undertaken, and clinical indicators on progression to univariable and multivariable Cox sight‐threatening diabetic proportional hazards models were retinopathy (STDR) among those then fitted using the matched with mild non‐proliferative diabetic samples. Concordance statistics retinopathy (NPDR). were calculated for each model.
We carried out a historical cohort A total of 1037 (5.5%) STDR study of 18,978 adults (43.63% diagnoses were observed over a female) diagnosed with type 2 mean follow‐up of 3.6 (SD 2.0) diabetes before 1 April 2010 and years. HbA1c, blood pressure and mild NPDR before 1 April 2011 was cholesterol indicator attainment conducted. The data were obtained were associated with lower rates of from the UK Clinical Practice STDR (adjusted hazard ratios [95% Research Datalink during 2010‐ CI] 0.64 [0.55‐0.74; p < .001], 0.83 2017, provided by 330 primary care [0.72‐0.94; p = .005] and 0.80 [0.66‐ practices in England. Exposures 0.96; p = .015], respectively). included attainment of the Quality and Outcomes Framework HbA1c Our findings provide support for (≤59 mmol/mol [≤7.5%]), blood meeting appropriate indicators for pressure (≤140/80 mmHg) and the management of type 2 diabetes cholesterol (≤5 mmol/L) indicators in primary care to bring a range of in the financial year 2010‐2011, as benefits, including improved health well as the number of National outcomes—such as a reduction in Diabetes Audit processes completed the risk of STDR—for people with in 2010‐2011. The outcome was type 2 diabetes. time to incident STDR. Nearest HOME & AWAY
WHO CC INITIATIVES ON COVID-19
Since the start of the pandemic last year, WHO Collaborating Centre have been engaging in a wide range of activities with WHO, such as:
• Being part of the technical advisory committee for COVID-19 • Being part of the supreme advisory committee for COVDI-19 in Iraq • Being part of the advisory committee for COVID in UAE
As the Centre remit is Education and Training, over 20 educational webinars have been delivered through WHO CC on COVID-related topics, from surveillance and primary care services to mental health and self- care during the pandemic. All webinars can be accessed on our website.
Additionally, the Centre has been collaborating with WHO Iraq, carrying out the assessment of the situation following the first wave. Plans were put in place for dealing with transmission issues, developing public health responses, restructuring public health laboratories, supporting segmentation of hospital, and changing the role of primary care. This task continues, as the pandemic evolves.
Moreover, a Health systems resilience project in collaboration with the Arab Public Health Association (ArPHA) was initiated in the last few months. Since the onset of the COVID-19 crisis on public health, managing the ever-increasing number of patients admitted to hospitals and ICU units while maintaining health services at the regular pace Image by @rawpixel.com via freepik.com
proved to be difficult in many parts of the world. The first stage of research aims to develop and validate an assessment tool for health system resilience. This tool will be valuable for measuring health system resilience in countries, help identify and find ways to minimize critical gaps in health systems and improve their performance during and after any kind of shock on the healthcare system.
COLLABORATION WITH CDC IN THE KINGDOM OF SAUDI ARABIA
The collaboration with CDC, currently known as the Public Health Agency, in Saudi Arabia on the transformation of public health workforce in the Kingdom, which has been flourishing for nearly a year now. It involves all aspects of training for practitioners and the wider public health workforce.
New criteria have been developed to ensure accurate assessment of the needed competencies in the field after a benchmarking and situational analysis has been done with multiple interviews with stakeholders.
As part of this collaboration, WHO Collaborating Centre will deliver seven structured courses needed in the region, and a strategic and operational plan has been developed on how to successfully sustain the development for multiple years.
Five minutes with… Chido Cambarami Support Officer
What does your role involve and what do you enjoy about it?
My role is WHO Support Officer for the Collaborating Centre team. It involves but is not limited to: Assisting my Project manager and the WHO CC Team with materials needed to execute projects. Helping with the documentation of various phases of projects. Liaising WHO CC and Public Health department as well as various organizations, facilitating communications and keeping appropriate parties updated on project developments. Conducting research and the gathering of key information for use in upcoming projects. Managing online communications, from social media, email and our website sources. PCPH/WHO CC provides the essentials skills and knowledge needed for my career progression.
What do you enjoy most about your role?
Though my role is under the umbrella of Support Officer, I liken it to ‘Dora the explorer’. With every present day, I’m faced with new possibilities, new tasks, projects and adventures. Climbing up any mountain is no easy task but having the team to climb alongside me echoes a song of perseverance whenever I feel discouraged or overwhelmed. Climbing the mountain is what I enjoy, embracing the challenges and taking on the new unchartered grounds.
What were you doing prior to this?
I was a Wellness Coach for ‘Solutions4Health’. My work included Smoking Cessation Support, Healthy Weight Management Programmes, Falls Prevention and NHS Health Checks.
What are your outside interests and who are you outside of work?
Outside of work, I thoroughly enjoy Flag worship dance, travelling, cooking and watching MasterChef. My place of origin is Zimbabwe, located in the southern hemisphere of Africa. I have been living in the United Kingdom for over 15 years. I love food and have a keen interest in learning cooking styles and recipes from various nations.
What are your goals for the next few years?
In the next few years, I will be a multi-business owner. I became interested in Public Health due to my concern in the increase of Childhood Obesity so as a result I aim to have healthy food chains across the world.
What 3 tunes and luxury item would you choose to be marooned on a desert island with?
My three tunes would include: Bryan & Katie Torwalt - Holy Spirit Michael W.Smith - Agnus Dei DappyTKeys - 8 Hour Relaxation sleep music
Luxury item: Holy Bible
Image: @bedneyimages via freepik.com Would you like to have students to help with your Covid vaccination delivery? If you have opportunities that medical students could assist you with we would be happy to signpost students across all years to help with your vaccination programme – this could be either within your practice or at a local vaccination hub that you attend. If you are interested in/have a need for this please provide some basic details about the roles (see below) to the Primary Care Faculty Development Manager, Nadine Engineer, and we will include your opportunity on our online noticeboard - students can then contact you direct if they are able to help: • Role location • Roles available e.g. ushering, registration, making phone calls, giving vaccinations etc • Training requirements • Payment (if applicable) & approx. hours • Contact person for students to liaise with Students and tutors are asked to ensure that involvement does not interfere with MBBS studies