INSIDE AUTUMN 2021 The magazine of the Royal College of Paediatrics and Child Health Child and Paediatrics of College Royal the of magazine The inclusion in healthinclusion Accessibility and Accessibility Open to all Page 11 Page TIME COVID OF SLEEP IN A The scheme to scheme helpThe IMGs find their feet find IMGs Soft Landing Soft Page 12 Page prepared for asurge for prepared How we can be best best be we can How Bronchiolitis Page 14 Page A woman’s experience Women at work in paediatrics paediatrics in Page 16 Page

Contact We’d love to hear from you – get in touch at milestones@ Contents rcpch.ac.uk Autumn 2021 Welcome It gives me great pleasure to welcome you to the autumn edition of Milestones. It’s been another crazy year when it comes to holiday planning and if you’re like me and plan holidays months in advance – I share your pain but I trust you got some relaxation and family time over the summer. 14 There was a time when paediatricians looked to the summer for an opportunity THIS ISSUE to catch up on CPD, invest in team building 16 12 Soft Landing 20 COVID-19 in the well- activities and enjoy a few months of slightly A programme designed to trodden path of Ebola less frantic working. 2021 will not be one of welcome newcomers to the UK How Liberia has coped with those years. Many colleagues have been COVID-19 soon after its Ebola heard to say, “Winter started in June – what 14 Bronchiolitis outbreak will November/December/January be like?”. The rise in cases and how we can It has been a very unusual few months but prepare for the next few months 21 A shielding trainee I am really proud of how everyone has risen How creative thinking kept one to the occasion and worked with colleagues 16 Experience as a woman trainee busy and involved in primary care to do their very best to in paediatrics Addressing some of the issues support our patients and their parents with facing women in our profession EVERY ISSUE the very large number of viral infections. 4 Update This bodes well for the winter months when 18 Simply the breast? we doubtless will need to dig deep into our RCPCH news, training Three doctors share their opportunities, and more reserves of goodwill. breastfeeding experiences My best wishes – and take care. 11 RCPCH &Us Camilla 19 The Synapse Centre for A three-point plan to improve RCPCH President Neurodevelopment inclusivity and accessibility @CamillaKingdon A new centre for research 22 Members News and views from members EDITOR'S PICKS Myself and the rest of the editorial team really hope you enjoy our latest 27 International offering! Thank you, as always, to all that have contributed. Diffi cult to pick Working in the UAE my highlights this edition as there are many! As well as our usual features (and suspects) we have a timely article from Sanjay Patel sharing some 28 Wellbeing thoughtful refl ections on the impending RSV surge, wise Demi from The importance of sleep RCPCH &Us gives us three simple tips to use when thinking about accessibility and the brilliant Mike Farquhar discusses some of the factors that have impacted on the sleep/wellbeing of paediatricians. On that note, stay well and look after each other! 30 A Day in the Life Dr Hannah Baynes Dr Stephanie McCallion on the paediatrician who inspired her

Copyright of the Royal College of Paediatrics and Child Health. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopying, recording, or otherwise – without prior permission of the publishers. The views, opinions and policies expressed in Milestones do not necessarily reflect those of the College. While all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted for any error, inconsistency or omission. Products and services advertised in Milestones are also not recommended or endorsed by the College. Readers should exercise their own discretion and, where necessary, obtain appropriate independent advice about their suitability. Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SC038299). Registered address: 5-11 Theobalds Road, Holborn, London WC1X 8SH. Head of Design: Simon Goddard Project manager: Lizzie Hufton Publisher: James Houston. Milestones is published four times per year on behalf of the Royal College of Paediatrics and Child Health by James Pembroke Media, 90 Walcot Street, Bath, BA1 5BG. T: 01225 337777. Advertising: Alex Brown, Head of Corporate Partnerships [email protected]

EDITORIAL Managing editor: Aisling Beecher @AislingBeecher Editorial board: Dr Seb Gray @SebJGray Dr Hannah Baynes @HLB27 Dr James Dearden @drjamesdearden Dr Dita Aswani @DrDita Dr Maddy Fogarty Hover @I_am_spottacus

KEEP IN TOUCH @RCPCHTweets @RCPCH @RCPCH [email protected]

Milestones AUTUMN 2021 03 KEEP IN TOUCH We’d love to hear from you, get in touch through our channels Twitter @RCPCHTweets Facebook @RCPCH Instagram @RCPCH The latest news and views [email protected]

DIVERSITY One year on from Putting Ladders Down

IT HAS BEEN a year are committed to listening and learning as us to do better. A particular highlight since the release of practice evolves. for me has been working with Segn the RCPCH Equality, Working with colleagues on EDI has Nedd, our EDI representative on the Diversity and Inclusion been a pleasure. Camilla Kingdon as Trainees’ Committee on plans for Dr Bhanu (EDI) Report Putting President and Rob Okunnu as senior reciprocal mentoring – a scheme where Williams Ladders Down. staff lead have both provided energy more junior members of our College Consultant Paediatrician Our One Year On and wisdom to our endeavours and from traditionally under-represented London North West report examines our Natasha Neill (Chief of Staff) and backgrounds, work with senior officers Hospitals NHS Trust progress against our Carlota Navarro Esperse (EDI lead) to share experiences and improve @BhanuWilliams initial findings and have worked tremendously hard to engagement. As ever, the young people we recommendations. drive our progress forward. work with lead the way in educating us; Putting Ladders Down was commissioned I am delighted with the member I found the CYP session on experiences to focus on EDI with regards to our engagement with the EDI work, both of trans teenagers seeking healthcare at member involvement in voluntary roles within the member reference group and the Annual Conference to be very thought and the One Year On report focuses on more widely. The conversations have provoking and it has impacted positively progress around this issue. We have always been interesting, educational on my practice. made good progress in terms of data and full of constructive challenges for I’ll end with two requests to my collection, embedding EDI at the heart colleagues. Please fill in the new diversity of the College and communicating with monitoring form, available on the website. our members, made roles more accessible “The conversations And please continue to be in dialogue with by removing the requirement to be a us on all areas of EDI that impact on your fellow from many roles and invested in [about EDI] have always working lives and on the health outcomes IT to allow appropriate evolution of ways been interesting, of the children and young people for of working. There has been a continual educational and full of whom we care. focus on best practice in use of language in sensitive areas of EDI. We recognise constructive challenges For more information on the College’s we won’t always get things right, but we for us to do better” EDI work www.rcpch.ac.uk/edi

04 AUTUMN 2021 Milestones UPDATE Rest is best Dr Mike Farquhar on the importance of good quality sleep (see his quick sleep tips through these pages)

P28 DIVERSITY FACTS Staff SCREENING Spotlight 2030 E VALUATION OF BY 2030 VOLUNTEERS SCREENING FOR ACROSS THE COLLEGE WILL SEVERE COMBINED REFLECT THE DIVERSITY OF OUR IMMUNODEFICIENCY MEMBERSHIP IN SEPTEMBER 2021, it is planned to start an evaluation of newborn screening for Severe Combined Immunodefi ciency (SCID). This will cover approximately two thirds of babies born in England. Each year, approximately 14 babies are born in England with SCID. There is now a substantial body of evidence that early detection, by 64% newborn screening, and timely treatment, OF OUR MEMBERS before babies contract infection, makes ARE WOMEN Carlota Navarro a substantial difference to mortality and Esperse morbidity, such that most patients lead a normal life, free of medication. Equality Diversity and Inclusion (EDI) Project Officer 32% In the UK, the blood spot, collected at fi ve OF OUR MEMBERS days old, is used to detect nine conditions, I JOINED THE COLLEGE in February this ARE UNDER 35 including sickle cell disorders, cystic year. My role is to support the development of fi brosis, congenital hypothyroidism and six the EDI work at the College by working very metabolic disorders. From 6 September closely with Natasha Neill (Chief of Staff), as this year all initial bloodspot samples well as liaising with the EDI Staff Working received in laboratories covering about Group, the Oversight Group and the EDI two thirds of births in England will be Member Reference Group. tested for SCID. Any babies with abnormal I am very passionate about the work I results will be referred urgently to their do as I believe EDI is essential towards 1 % local immunology specialist for diagnostic achieving a more equitable society, by creating UNDER 1% OF assessment and management. The MEMBERS DISCLOSED advancements and programmes to ensure that A DISABILITY OF ANY evaluation will run for two years, after which everyone has access to equal opportunities. KIND COMPARED a report will be submitted to the National Our report Working for Change sets out the WITH 21% OF ALL UK Screening Committee, so that it can make CITIZENS College’s current key areas of EDI work. These an appropriate recommendation to the reports are centred around the working lives of Ministers of Health for all four nations. paediatricians, health outcomes for children and ETHNICITY young people, College volunteering and awards, AT RCPCH and our College as an organisation. 1% Outside of work I am part of a volunteering 16% UNDISCLOSED 26% programme run by Chance UK which involves UNKNOWN ASIAN mentoring and working with children and their carers to create a brighter future through a 3% 47% solution-focused and trauma-informed approach. BLACK WHITE Dr David Elliman We support children and help them identify their Clinical Lead for the Newborn Blood Spot strengths, as well as express their feelings, to 1% 6% Screening Programme enable them to imagine their preferred future. MIXED OTHER Public Health England

Milestones AUTUMN 2021 05 MIKE’S SLEEP TIPS UPDATE Limit caffeine use. Too much caffeine later in the day can affect sleep quality College news See page 28 STUDY BPSU study on FGM

IN 2014, THE first and still only clinic for children and young people who have undergone or are at risk of FGM was opened at University College London Hospital by me and Professor Sarah Creighton – ROYAL COLLEGES Dr Deborah Paediatric Gynaecologist. Mindful COLLABORATING Hodes of the importance of supporting the Consultant physical and psychological impact of Community THERE ARE TIMES when we come together with Paediatrician FGM, the clinic is multidisciplinary other Medical Royal Colleges that demonstrate The Lighthouse, including psychotherapists and a UCLH how powerfully doctors can use their voice on the clinical nurse specialist. right issues. In the BPSU study, only 103 We saw that happen this summer. With GP and girls were reported over two years. This and other emergency medicine colleagues, we warned that research suggest that there may well be a change in Jo Revill a very high number of babies and young children the attitude of the diaspora for girls whose mothers RCPCH CEO were being brought into emergency departments, have been cut. However, we need to be alert to the @8jorev many with mild fevers and symptoms that would possibility that it does take place. In 2019 there was be better treated at home. We produced advice a successful prosecution in London after a three year for parents and carers, explained what to look out for and conveyed old presented to Whipps Cross Hospital. the impact on services of such high demand. Above all, it was about It is important to have the confidence when taking trying to help parents make the right decision for their child at a a family history to include FGM. It is also important time of real concern for them. to remember that taking a good family history Colleges collaborate every day on a great raft of projects, includes knowing the country of origin of the parents guidance and urgent national issues that cut across the specialties, and asking about relevant conditions which includes but I don’t think this is always seen from the outside. Perhaps FGM. So, having asked about illnesses to introduce we need to improve the way in which we demonstrate that the topic, I will then ask about FGM. Questions could collaboration. Webinars and virtual events featuring other areas include, “You may have read about FGM, traditional of work are a smart way to do this ensuring that, as Colleges, we cutting of women and could I ask if you come from showcase each other’s impact on patient care. a practising community?”. If the answer is yes then This summer, we turned 25 years old and celebrated the the next question to the mother would be, “Have you extraordinary way in which paediatrics and child health has been cut?” and lastly “What do you feel about your developed over the years with stories from members and from daughters?”. young people. From the fi rst 60 members of the British Paediatric Given how families feel so stigmatised by the Association to more than 20,000 today, the granting of that Royal way they are often treated by police and social care Charter in 1996 enabled the profession to do so much more. In services, it is important that paediatricians are the same week, we had our busiest ever – and remote – Annual sympathetic independently of whether the girls have Conference, with topics ranging from the climate change been cut. emergency to thoughts about paediatric leadership. More than Importantly if you do see a case and you’re not sure, 1,700 attendees joined from 44 countries across the world – a feat do not hesitate to send the video image for a second that remote technology allows us. Next year, we are back ‘in real life’, opinion to the UCLH clinic and if necessary the child we hope, but will hold onto the best parts of this innovation. can always be seen; it is better to be certain of your findings before possible prosecution. Read the advice for parents and carers on fever in children www.rcpch.ac.uk/ed-dramatic-rise Visit www.rcpch.ac.uk/bpsu/fgm

06 AUTUMN 2021 Milestones MIKE’S SLEEP TIPS Restrict your use UPDATE Welcoming IMGs of electronic Find out how the Soft Landing scheme screen devices in the is easing the transition to working for hour before bedtime the NHS for doctors new to the UK See page 28 P12

AWARDS MEDICAL STUDENT ANNUAL PRIZE AWARD 2021 Dr Emily Payne Community EVEN BEFORE STARTING medical school, Paediatric Consultant I had a keen interest in paediatrics. Having Cwm Taf Morgannwg University volunteered on a paediatric ward whilst at Health Board sixth form, I was always amazed by the work that the paediatricians did and the difference CLIMATE they made to the lives of so many children. This interest continued into my university Taking action on climate change placements, and I have recently completed my elective in paediatric emergency medicine and I’M THE CHAIR of the Support for also have seen sustainability and community child health. I was also the Vice- Members workstream of the Climate climate change were given more President of my university’s Paediatric Society. Change Working Group (CCWG) prominence at the College’s Annual I am absolutely thrilled to have won one of in the College. I volunteered for Conference (and hopefully in your the RCPCH Medical Student Prize Awards. this role as we have abused and own specialty conferences and As part of the prize, I was fortunate enough overused our habitat and now departmental meetings!). to attend the RCPCH Annual Conference. need to nurture it to health so our The aims of our workstreams are: I attended all three days, and even though children have a healthy future. I To identify the needs of members it was virtual I still really enjoyed it. Some was also finding that although I with regards to climate change. particular highlights included the ‘Social have a relatively ‘green’ lifestyle at To provide support to address Determinants of Children and Young People’s home, it feels like I’m walking into these needs. Health’ breakout session which raised a another century coming to work To determine the needs lot of important discussions, as well as the sometimes! of trainees and update the ‘RCPCH &Us Engagement Workshop’ where The College has set up the CCWG curriculum to reflect this. I enjoyed learning about inspiring projects to help deliver its climate change If you have questions or would involving young people. I also found the talk strategy. There are five workstreams like to share examples of good from the UK Aspiring Paediatricians Society supporting this: practice in sustainable healthcare, really useful as it gave a lot of helpful tips Advocating for Change please use [email protected] to regarding careers in paediatrics. There was a Research into Climate Change and contact us. As a starter, here are virtual social event organised in the evening Impact on CYP three suggested changes you can for medical student prize winners, which was a Toward Sustainable Buildings and make right now: great ending to a wonderful conference! Resources 1 Approach the executive board I am early on in my International of your health board/ trust to get career, but I am already Support for Members climate change on their agenda. really passionate about There’s now a website dedicated 2 Avoid taking flights wherever paediatrics and so to to the CCWG which will continue to possible. receive this award is such be developed and will likely form the 3 Prescribe tablets over liquid and a wonderful ending to platform on which much ‘support dry powder inhalers over MDI Emily Davis my time at university. for members’ can be found. You’ll inhalers where safe to do so. Final year medical I’m looking forward to student the future, and hopefully Find out more about the College’s work on Cardiff University joining the world of climate change www.rcpch.ac.uk/climate-change @emilydavis0701 paediatrics!

Milestones AUTUMN 2021 07 UPDATE

ANNIVERSARY JOURNAL 15 years of Medicines BMJ PAEDIATRICS OPEN for Children: where HITTING CHILDREN IS WRONG is the title of an editorial highlighting the progress we’ve come from and in countries legislating against violence towards children. It is one of our most read where we’re going papers. It highlights how England lags behind Scotland and Wales in protecting WHEN MEDICINES FOR CHILDREN Imti children. What is surprising is that was launched in 2006, the aim was to Choonara England and Northern Ireland are behind develop a trusted and accessible source of BMJ Albania, the Congo, Honduras, Nepal and Paediatrics Open free information on paediatric medicines Editor-in-Chief Turkmenistan. The latter are among the for parents and carers. Today, Medicines @BMJ_PO 59 countries that have passed legislation for Children hosts paediatric-specific recognising that hitting children is wrong. Dr Helen information on more than 220 medicines, Sweden was the fi rst country in the Sammons with over four million downloads a year. world to ban hitting children in 1979 and the editorial Consultant The website also includes information highlights the publicity aimed at parents explaining Paediatrician and Paediatric Lead on broader topics, such as the use of why hitting children was counterproductive. Surveys Northern Devon unlicensed medicines in children, and have shown that the attitudes of Swedish parents Healthcare NHS Trust videos demonstrating how to administer have changed with practically all now recognising that @MedsForChildren medicines by various routes. violence to children is wrong. Paediatricians can play a The medicines information has been positive role in changing attitudes, in England, Northern developed by an army of paediatricians Ireland and the other countries, where legislation (and and pharmacists, using a combination of standard phrases education) is still needed. (e.g. for dosing) and tailored information and images. All medical jargon is avoided. The medicines information JOURNAL is reviewed every three years or when new information emerges. The information covers concerns that parents told ADC JOURNAL UPDATE us they often face when giving medicines at home, such as: What if I forget to give it? Which side-effects must I do AS I WRITE, the gates of Wimbledon are something about? What if my child is sick? re-open, two years after the last serving of We continue to work with families through our partner strawberries and cream and clumsy, tabloid WellChild to understand what they need. In September punnery rife as the tournament approaches 2021 we are launching a new-look website with improved its denouement. So, this must be summer, functionality, and a free mobile app is being developed to the season where one can take feet off the help parents/carers keep track of their children’s medicines. Nick Brown gas for a few weeks, right? Not any more. Medicines for Children offers a readily available source of Archives We know from the Australian experience of of Disease in reliable information that clinicians can share with families. Childhood Editor- RSV (the ‘classic November infection’), that The project board is proud of our achievements to date and in-Chief a fourth COVID wave, despite the easing of would like to thank the many people who have helped get us @ADC_BMJ restrictions, and that priority group vaccine here. We hope Medicines for Children will continue to grow uncertainty are all lurking menacingly stage as a valuable resource, in collaboration with our partners left. If we’d wanted routine jobs, though, we’d WellChild and the Neonatal and Paediatric Pharmacists never have signed up for paediatrics. Group (NPPG). After sifting through a jaw droppingly high quality shortlist for our new Trainee Associate Editor positions, a joint journal and RCPCH initiative, we’ve just appointed two new Trainee Associate Editor positions each to both the ADC and Fetal and Neonatal editions. So, congratulations to Hadeel Hassan, Sunitha Vimalesvaran, Visit Medicines for Children Shiraz Badurdeen and Michelle Fernandez. Exciting on www.medicinesforchildren.org.uk many levels, not least the new ‘energy’ they will bring.

08 AUTUMN 2021 Milestones UPDATE

AWARD James Spence Medallist

IT WAS A GREAT HONOUR to I visit Bengt Robertson’s laboratory in What am I most proud of? That is receive the James Spence Medal for 2021, Stockholm 37 years ago. The European easy – my wife and family who have an award not just for me but for those research networks that we subsequently supported me through thick and thin. with whom I had worked during the developed in the 1980s allowed testing Marjorie and I have three children Professor past 50 years. I have been very fortunate in randomised trials of pulmonary and four grandchildren whom we Henry Halliday in having wonderful colleagues and surfactant which is now indispensable in love dearly. I am proud to say that our Retired mentors, first in Belfast and then in the care of preterm infants. children followed us into the caring Neonatologist Cleveland and San Francisco, people Since I retired from clinical practice, professions – we have a Consultant in Belfast who gave me an exceptional grounding I have been kept busy chairing many Intensive Care and Acute Medicine, a in neonatology and research. I was committees involving a veritable Consultant Paediatric Oncologist and a also lucky to meet so many good alphabet soup of clinical trials, trial Cardiologist. Hopefully we will be well colleagues, scientists and clinicians with steering, data monitoring, and research looked after in our dotage. similar research interests in Europe ethics committees in many countries. I was honoured to accept the James and worldwide. Colin Morley from I have also enjoyed being joint Editor- Spence Medal for 2021 and join a list Cambridge gave me great advice about in-Chief of the journal Neonatology for of most distinguished paediatricians continuing our research into surfactant the past 18 years with my good friend and others who have contributed to replacement for RDS when he suggested Christian Speer from Wurzburg. improving child health worldwide.

AWARDS AWARD HONORARY RCPCH &Us Voice FELLOWS 2021 Lord Victor Adebowale Chair of the NHS Confederation Champion Award Prof Zulfi qar Bhutta Chair of Global Child Health at Hospital I WAS DELIGHTED to receive the individual health service, seeking for Sick Children, Toronto and Director of the 2021 RCPCH &Us Voice Champion their voice. We successfully Centre of Excellence in Women and Child Dr Mike Award. The achievements by the employed our first youth worker Health, Aga Khan University Linney other nominees were awe-inspiring in our non-specialist hospital Dr Fiona Campbell Retired Consultant Paediatric Diabetologist / Paediatrician and all would have thoroughly this year, able to link in with Associate Medical Director (Children’s University deserved the award. support in the community, take Hospitals Sussex Services), Leeds Teaching Hospitals NHS Trust NHS Foundation Chairing (I use that term individual referrals, seek out those Dr Helen Goodyear Trust loosely!), our RCPCH Engagement on wards who were struggling to Consultant Paediatrician, Birmingham Past RCPCH Committee taught me to listen, get their voice heard and engaging Heartlands Hospital Registrar Dr Jenny Harries @linney_mike respect and follow the young with young people to develop a person’s voice. I was able to better service. Deputy Chief Medical Offi cer for England meet and talk to many young Finally being able to help write Prof Aye Aye Khaing Professor of Paediatric Oncology, Yangon people engaged with healthcare, a book chapter on children’s Children’s Hospital, Myanmar listening to their stories and healthcare engagement from Prof Kyaw Linn achievements, both as individuals these experiences and supporting Professor of Paediatric Neurology, Yangon and collectively. This helped when RCPCH &Us through all their Children’s Hospital, Myanmar I met senior healthcare decision- COVID work (for example Dr Robert Scott-Jupp makers, making me a better the ‘book club’ on children’s Retired Consultant Paediatrician, Salisbury NHS Foundation Trust advocate for children. experience during COVID) was Dr David Vickers Leading from all this, I saw the hugely rewarding and something I Medical Director & Consultant Paediatrician, value for youth workers in helping remain very proud of. Cambridgeshire Community Services young people engage in their Thank you again for the award. NHS Trust

Milestones AUTUMN 2021 09 MIKE’S SLEEP TIPS UPDATE A small amount of alcohol can help some Simply the breast? Three doctors explain how their people to relax, but closer own experiences helped them to bedtime it can negatively support breastfeeding mothers affect sleep quality See page 28 p18

Read more Find more dates at EVENT www.rcpch. ac.uk/courses RECORDINGS www.rcpch. ac.uk/events Managing RSV and other Diary Dates respiratory viruses in 2021 This webinar looks at how to Here is a selection of our online and eLearning courses. manage patient fl ow, ‘keeping More courses will be confi rmed in the next few weeks so patients safe and pathways keep an eye on our website for further updates open’, covered recognition, management and discharge, and signposting to resources MRCPCH Theory Webinar: Childhood DCH Clinical exam for parents. & science exam obesity – medical preparation preparation course management 3 Nov BPSU-PHE Symposia series: 3 Sep 16 Sep COVID-19 from a Paediatric How to Manage: Perspective MRCPCH/DCH How to Manage: Paediatric sepsis Discussions cover the impact Foundation of practice Paediatric Allergy 4 Nov of COVID-19 on pregnancy, exam preparation Training PAT 3 neonates and general paediatric 8 Sep 22 Sep How to Manage: populations and the rare FASD in community syndrome, PIMS, as well as the RCPCH-BPSU Webinar: Childhood paediatric services wider impact of Webinar: Lead obesity – surgical 16 Nov the pandemic on toxicity in children – a management child health. continuing problem 23 Sep How to Manage: 8 Sep Common cardiac How to Manage: problems MRCPCH Clinical Eating disorders 19 Jan 2022 exam preparation 6 Oct See more Free online event recordings 13 Sep www.rcpch.ac.uk/live-event-recordings

IS THIS ADVERT RIGHT?

10 AUTUMN 2021 Milestones RCPCH &US Accessibility and inclusion in health Demi, a member of RCPCH &Us, tells us what accessibility means to her and gives her three-point plan to improve inclusivity

ACCESSIBILITY For the RCPCH Annual Conference comprehend why it has taken so long to be IS IMPORTANT this year, Dr Fizz Izagaren and I met able to wear clear face masks. This would to me because I and spoke about accessibility and some help patients and health staff not just have experienced of its advantages as well as it flaws. In who are deaf but also who have learning the frustration of our interview we spoke honestly about disabilities, English as a second language not being able to do our life experiences and she explained and other things. Demi something without the difficulties she has faced throughout I think everywhere needs to have a Aged 16 planning it first. COVID-19 and before with being deaf and three-point plan that they use to check I know first- having full communication access. I can’t their accessibility, in a project, in a clinic hand how it can impact a person and or in other parts of life. This could include: their family’s daily life too. My older brother is deaf and has cerebral palsy so Diverse Check their communication needs – do it’s something I’ve witnessed on a daily role 1they need a voice over, subtitles, large basis. Having to ask questions like, “Is print, or pictures? there access via a loop system?” or, “Can models he access that with limited mobility?” or, in films Check their age and stage ability – “Can we do it together or independently?” 2do they need an easy read version, but the answer isn’t always yes. Central Bedfordshire Youth someone to explain it? Accessibility has different meanings Parliament have selected five depending on who you ask. However, diversity films which feature Check their access needs – how can I believe that accessibility is inclusion role models from different 3they get to see you in person or online for everyone, always with the adaptions backgrounds, understanding with as much independence and dignity and flexibility being available to all. different cultures and as possible. Communication is another factor of experiences, or having different accessibility as well because people experiences to others. Have a think about the three-point plan have the right to ask questions and be 1. Wonder and see what you can do in your team heard, using the language that works for 2. Moana to make it more accessible to patients, them, whether this is via a translator/ 3. Raya and the Last Dragon families, and staff. Also look to see young communicator, symbols or subtitles, so 4. 13th people’s ideas for films with diverse role accessibility has many factors. 5. Coco models (left) too!

ABOUT

RCPCH &Us: The Children and Young People’s Engagement Team delivers projects and programmes across the UK to support patients, siblings, families and under 25s, and gives them a voice in shaping services, health policy and practice. RCPCH &Us is a network of young voices who work with the College, providing information and advice on children’s rights and engagement.

KEEP IN TOUCH @RCPCH_and_Us @rcpch_and_us @RCPCHandUs [email protected]

Milestones AUTUMN 2021 11 FEATURE

Soft Landing – supporting paediatricians new to the NHS The founders of a new organisation run by international medical graduate paediatricians tell us how they will be supporting those from overseas to make the transition a little easier

he inspiration for TSoft Landing came from my own personal experience of moving from the Middle East to come to work at a tertiary neonatal unit Dr Nadia Baasher in East London. For a ST7 Paediatric long time, I had a real Trainee aspiration to achieve The Royal London the internationally Hospital recognised qualification of UK training in paediatrics. I met a consultant who was working in London at my hospital overseas, and he encouraged me to consider coming. At that The Soft Landing team point, I was really settled in my job and my family life in Saudi Arabia, but it was kind of now or never… so I packed up my whole life and my family’s life and moved. I was very fortunate that the department something official. It’s not just a course but I am actually half-Irish and knowing the I arrived at and my SHO on my first on calls wanting to have a team available to support language and the culture from visiting lots took very good care of me and helped me to people who are newly arrived and trying to of times, I didn’t expect the big adjustments thrive. But it is not like that for everyone. find their feet. to working in the NHS. The struggles I It was at that point that I started working The team grew quickly. The enthusiasm encountered even in the communication, with Habab on helping people who were that came from many quarters, not least were not a language issue, but more about hoping to come and train here. I started Camilla Kingdon’s generous encouragement, the style of education abroad which is quite to hear about the difficulties people were seemed to suggest that this was something restrictive – you don’t have a chance to having in departments who were less lucky. valuable that we could offer to these doctors, express or even discuss. In some countries Some of the departments weren’t used to at very formative moments in their careers. the health systems have an almost military- international medical graduates (IMGs) I am grateful to work with such an like hierarchy, unlike the UK. In spite of this, and some of the IMGs themselves were amazing passionate team and I am hoping handover is very informal. Clinically, I had not prepared. we can reach out and enable a ‘softer landing’ nine years of paediatrics experience, but I It started as an idea on a word document, for IMGs and a softer reception for the struggled at the start. but we quickly realised we needed to do departments they are joining.

12 AUTUMN 2021 Milestones FEATURE

ettling into a Our pilot workshop took place virtually How you can help Snew healthcare with a full-day of lectures and Q&A IMGs transition to system and a foreign sessions covering a day in the life of an NHS working in the NHS country comes with paediatric doctor, surviving your first on- Always ask about IMG many challenges. call, understanding the MDT, tips for proper colleagues’ experience and Without the right documentation, safeguarding and wellbeing. level of familiarity with the support these During this workshop, we were proud NHS system. They could be Dr Habab Easa challenges can have to introduce our very own Soft Landing a paediatric consultant, or ST4 Paediatric Trainee detrimental effects on communication skills videos, filmed using this could be their fi rst job in Oxford University the personal, social our very own resources and acted by our paediatrics! Hospitals and professional lives team members. The contents of those videos Be aware they may have left of IMG doctors, resulting in differential were inspired by real work-life scenarios family and friends to start attainment, retention issues, even in that are usually encountered daily (handover work in the UK. Isolation can extreme cases mental health problems. to a colleague, talking to a difficult parent, be an issue so invite them for As IMG doctors, who have gone through and escalation to consultants). Crucially the a cup of tea. some of the hardships ourselves, we think doctors in the videos reflected the varied Introduce them to this transition could have been made accents and appearances of many of our other IMGs who are easier if IMG paediatricians received the audience. All the other sessions highlighted more established or offer right support at the start. Nadia and I had cultural pitfalls that IMGs may run into. a mentor, in addition to a vision of a supportive network for IMG The feedback was hugely positive from the their educational supervisor paediatricians that provides customised candidates and from our peers who kindly for more informal trouble- training, mentoring, signposting, and attended the workshop as reviewers. We shooting. peer support, by IMGs who are further intend to deliver this workshop two or three established in their UK careers. times a year. The main areas of struggle are not Other interactive sessions so far have related to clinical skills or knowledge, but included ST1 mock interview sessions, as interpersonal skills like communication, well as ST3/4 sessions lined up with nearly situational awareness, and knowing how 90 candidates registered. Our plan is for to access the right support channels. A regular webinars for UK IMGs addressing number of challenges were identified from their specific needs; career progression/ a survey we conducted with over 100 CESR, untangling ePortfolio, smashing IMG paediatricians. In particular, past ARCPs, wellbeing in the workplace and experiences of escalating to the consultant paediatric mental health. We hope to were discouraged, you were considered a continue with webinars aimed at overseas bad registrar if you get your consultant up colleagues who are planning to move to the at night – of course this is the exact opposite UK with topics covering GMC registration, of paediatric working in the UK where it NHS job applications and life in the UK. is vital that you keep your consultant up to Our dream for Soft Landing is a national date. MDT working is also very different. hub, with a mentoring programme and peer Another thing was the admin – in many support network. The project arose through overseas settings, doctors do not have to the good deeds and pure voluntary efforts of complete the amount of admin that is normal our ever-growing team, and it has been truly @paedsoftlanding in the UK. humbling to see how much can be achieved Team.softlanding.com By providing customised support in from the desire to help others. To our fellow Soft Landing terms of workshops and webinars exploring paediatricians, we hope to unleash the full the topics that most IMG paediatricians potential of this valuable asset within the are struggling with due to lack of previous NHS workforce, for better job satisfaction, experience, the gap in differential attainment and retention of the workforce. between IMGs and the UK-qualified paediatric doctors could be bridged. Visit www.soft-landing.org

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What can we do to prepare for a bronchiolitis surge? DR SANJAY PATEL LOOKS AT THE RISE IN CASES, WHILST PREPARING FOR THE POTENTIAL IMPACT IN THE COMING MONTHS ON PAEDIATRIC SERVICES AND PRIMARY CARE

ho would been exposed to respiratory viruses (except order to deliver safe care if the number have SARS-CoV-2) over the past 18 months, of bronchiolitis admissions increases W predicted we have a large pool of susceptible young sharply. However, the ongoing use of that we’d see almost no children with and without co-morbidities. the national COVID-19 specific red/ infants admitted with In terms of when this rise in cases is amber/green pathways continues to bronchiolitis in the UK likely to occur, there remains considerable make achieving efficient patient flow Dr Sanjay Patel during winter 20-21? uncertainty. Active surveillance data extremely challenging in almost all parts Consultant in Although it seemed like from sentinel sites across the UK are of the hospital. However, these pathways Paediatric Infectious a blessing at the time, already showing a rise in cases of RSV were primarily introduced to reduce the Diseases and Immunology with a large number in the North West of England, mainly in nosocomial spread between adult patients Southampton of paediatric staff young children and we’ve just heard that in hospital; within a paediatric setting Children’s Hospital being redeployed to NHS England is suggesting restarting these pathways are now hard to justify @doctorsanjay support adult services, the palivizumab programme for the most when we know that SARS-CoV-2 so rarely it appears that viruses may have the vulnerable young children. Whether or causes severe illness in children and most last laugh once again. Data from the not numbers will rise sharply in the next staff members have received two doses Southern Hemisphere are obviously few weeks and whether or not this will be of a COVID vaccine. They also take no concerning – large surges in Respiratory replicated in other regions of the country account of other respiratory viruses that Syncytial Virus (RSV), including remains unclear; we know from SARS- can result in nosocomial transmission to children beyond infancy, occurring out CoV-2 that considerable regional variation patients and staff. of season have put significant pressure is possible. In addition, the impact of school on paediatric services. summer holidays and whether or not this Achieving balance Will the same occur in the UK this will make the surge more likely to occur So how much influence do paediatricians year? To be honest, we don’t really know. when schools go back in September is also really have in implementing pragmatic Modelling from Public Health England hard to predict, although early data from processes that will allow patient flow to be (PHE) suggests anything from a 100% Scotland, where schools broke up in late maintained during a bronchiolitis surge? increase in admissions to an actual June, are encouraging. Irrespective, we The delivery of effective IPC relies on reduction in cases compared to historical as paediatricians need to be prepared to carefully balancing the risk of nosocomial averages. However, in my opinion, it seems manage a large number of children with spread of infection whilst still being able likely that as we ease social restrictions bronchiolitis potentially in the coming to safely deliver clinical care to patients. as part of the governments’ COVID-19 weeks and months. There isn’t a one-size-fits-all approach as roadmap to recovery, we’re probably going Maintaining patient flow between no two hospitals look the same; conducting to see a significant uplift in transmission EDs, short stay units, inpatient wards, a local risk assessment is essential. The of all respiratory viruses. And with high dependency units and paediatric good news is that we’re hopefully moving pregnant women or children not having intensive care units is paramount in away from COVID-specific infection

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“We need to recognise that a surge in bronchiolitis is going to impact our colleagues in primary care as much as us in hospital”

total triage model during the pandemic and their capacity to see large numbers of patients with symptoms consistent with COVID in Cases of bronchiolitis were face-to-face settings remains limited. Clinical lower than usual pathways and educational resources for the last winter remote assessment of children have been developed for primary care staff and effectively control pathways to more generic respiratory aware that a surge in bronchiolitis is predicted implementing them may allow precious face to infection pathways, which will describe good to occur out-of-season this year and that face slots to be used more effectively. Ensuring IPC practice whilst making it clear that local timely access to rapid test results in children is consistent approaches and clinical pathways teams should have the final say on which essential in order to maintain patient flow and across the urgent care pathway may also systems are put in place. This approach is deliver paediatric services. reduce the number of children being referred reflected in the recently updated RCPCH to hospital during a bronchiolitis surge. We bronchiolitis guidance, which highlights Working with colleagues should be promoting collaborative working the importance of local risk assessment as Finally, we need to recognise that a surge in between primary care and secondary care staff well as a more pragmatic approach to PPE bronchiolitis is going to impact our colleagues to deliver such integrated models of care. use. NHS England is also in the process of in primary care as much as us in hospital. Being prepared means having systems cascading this guidance down to infection We’ve seen record numbers of children in place before the bronchiolitis surge control teams across the country, many of presenting to primary care and ED with begins. I suggest meeting with your local whom have previously had no involvement in self-limiting febrile illnesses over the past infection control team and conducting a the infection control aspects of children with few weeks. It appears that reduced rates of local risk assessment, talking to your local bronchiolitis. However, the onus is still with us infections in children over the past 18 months microbiology/virology team to ensure that you as paediatricians to initiate these discussions may have reduced the confidence that parents can get rapid respiratory virus PCR results on with our local IPC teams and operational have in their ability to distinguish severe children and collaborating with your primary managers if we want to ensure that we have from mild illness. RCPCH has developed care colleagues to ensure that a consistent effective systems in place that allow us to excellent guidance for parents and we should approach is implemented across the urgent deliver safe care to large numbers of children be working with our colleagues in primary care pathway. I can’t promise that this will get whilst minimising the risk of nosocomial care and local authorities to disseminate this. us through a bronchiolitis surge unscathed but spread of respiratory viruses between patients In addition, primary care has moved to a it’s a start. and to staff. Another area that we as paediatricians Useful Links need to urgently address is ensuring that our Bronchiolitis guidance www.rcpch.ac.uk/bronchiolitis-covid-19 patients have access to either point of care Advice for parents and young people during coronavirus www.rcpch.ac.uk/coronavirus-posters PCR testing or laboratory based rapid PCR Integrated models of care www.rcpch.ac.uk/qi-central/integrated-care testing for respiratory viruses. Throughout the Managing RSV and other respiratory viruses in 2021 – webinar www.rcpch.ac.uk/rsv-webinar pandemic, hospitals have prioritised access Clinical pathways – remote assessment what0-18.nhs.uk/ clinical-pathways-remote-assessment to these tests to adults. It is essential that we make our microbiology/virology colleagues

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My experience as a woman in paediatrics DR LIZZIE WORTLEY SHARES HER PERSONAL EXPERIENCES WORKING AS A WOMAN IN PAEDIATRICS AND ADDRESSES SOME OF THE COMMON ISSUES THAT ARISE

HERE IS a lot that I could remember through medical school that then arise at work for your patients as to celebrate and beyond reached 4,000 words and I soon a safeguarding issue, and the complex web about being gave up. It was too much. I didn’t want it to be of emotions and thoughts being at work a woman in about one person’s experiences, but I wanted then brings. Being a trans woman. Being a Tpaediatrics – we make up it to have a ring of truth to it. single parent. Periods and menopause – the about 75% of trainees, Having many conversations at work and difference of opinion between using medicines Dr Lizzie consultants are about beyond, a lot of the common experiences to ‘remove the problem’, and those that don’t Wortley 50:50 and working were not being discussed on a larger scale, or can’t. Men at work can feel lost too – these Paediatric LTFT is so much and many women spoke about being too issues can apply to them too, and they may feel Registrar easier than in other scared or ashamed to talk about struggles even less able to discuss difficulties. University College Hospital professions. Discussing with colleagues and the difficulties that Issues can arise in paediatrics for women, @LizzieWortley inequalities through arose from that. men and families. Difficult areas for the lens of a woman’s We all know sexism still exists, and there paediatrics appear to be: experience would seem fairly pointless. were plenty of examples of that at all levels. Assuming our female colleagues want a A few months ago, I was asked to talk A number of experiences were around family and constantly asking about it – with at the RCPCH St David’s Day Conference significant issues it was felt weren’t being their abilities questioned if they don’t want about being a woman in medicine and what heard. Doctors experiencing domestic abuse, or have children. it means. With such a huge topic, but only 25 but not being believed (“You’re too clever Struggles with infertility whilst facing other minutes, there had to be some editing on what to let that happen to you!”). Experiencing families’ ‘success’ every day at work. I spoke about. Even my personal ‘incidents’ things within your family as a child or adult, Pregnant trainees not being supported,

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impact deciding to have children has on your career. The range of experiences is so broad there isn’t a one-size-fits-all solution. It does seem particularly hard in paediatrics to feel that building your own family can come with issues in a specialty that is about caring for babies, children and young people. Even women that actively choose not to have children can’t escape others’ assumptions and judgements, with their age, working abilities and life choices seemingly a reasonable source of work based opinion. I think the reality is we don’t really know what the impact being a woman has on working in paediatrics, because we haven’t asked people. I hope in the future we can be more proactive and open in the Being a parent and a paediatrician way we look out for and support people with can bring up conflicting experiences difficulties that may or may not be related to being a woman. even having miscarriages at work, when we I am now working with the College to have all cared for babies born sick, too soon write best practice guidance on pregnancy or too small. and miscarriage at work. The College’s Seeing families in ED/postnatal wards attitude to making positive change has struggling in the first few weeks of a been really encouraging. This is on top newborn’s life, whilst our colleagues go off of the work they have already been doing on parental leave with little support but with the phase 1 and phase 2 of their often complex and confused expectations equality, diversity and inclusion reports about breastfeeding. and recommendations which are vitally Returning to an on-call rota in a profession important and I wish them every success. that knows small children sleep badly; There is room for everyone in paediatrics, mothers may still be breastfeeding; and our professional and personal experience. and it shouldn’t be a zero-sum game. teaches the lifelong impact of the first Walking out of a discussion and the thoughts Paediatrics is special because of the different 1,000 days contributing to guilt, tiredness racing through our own heads. Trying to life stories and potential to help make things and stress. avoid bias without being able to acknowledge better. I really hope that in the future far fewer Being a parent in CYP centred paediatrics to our colleagues the reality of our lives, and people are scared to talk about the mismatch whilst feeling like your own family can’t the influence that has. between what they need in their lives and come into the equation. I was overwhelmed by the messages I what work is asking of them. This starts with All the complexities of life that we see and received when I started talking more about culture, and a lot of that comes from the top. can be mirrored in our own experiences – this. Comments around miscarriages at I love that when I contacted the College about complicated pregnancies; problems with work led to writing a piece about my own this, they jumped on it, listened and opened feeding; postnatal depression; domestic as I realised my experience wasn’t unique. up gates to get this heard. I’m really proud to violence; addiction; mental health; and The response was overwhelming, I couldn’t be part of something that has responded like hiding it for fear of judgment or reprisal. believe how many had negative experiences of that, and long may it continue! Parenting beyond babyhood, especially having to work during a miscarriage or being complex needs and adolescence when all too scared to tell anyone. We appreciate it would not be possible to that ‘should be sorted out’ by now. During the conference there was discussion represent everyone’s experiences in one feature, on what is a complex and sensitive topic. The There are lots of places where this is on staff fertility issues whilst always working editorial team would welcome hearing additional a problem – not just paediatrics. The with other people’s children; working whilst viewpoints for future editions. Please email difference for us is this mismatch between pregnant and having complications; and what [email protected]

Milestones AUTUMN 2021 17 FEATURE

SIMPLY THE BREAST? THREE PAEDIATRICIANS TELL US WHAT THEY HAVE LEARNT AS MOTHERS TO INFLUENCE THEIR PAEDIATRIC PRACTICE AND HELP THEM BETTER SUPPORT BREASTFEEDING

y breastfeeding has never been more important, in addition Multiple factors contributed to our feeding M experience to our role in recognising infants with difficulties. I now respect this delicate started promisingly, medical issues. Whatever our own level supply/demand balance and appreciate the with antenatal hand of experience, we can utilise experienced detrimental effect of overzealous top-ups on expression and my colleagues and allied healthcare professionals supply, especially when root causes of the daughter initially when suspecting technical breastfeeding difficulties aren’t addressed. Dr Jessica latching well. I hadn’t difficulties. And please signpost mothers to I spent the first months riddled with guilt Burke previously considered local infant feeding support groups, many and tears over my breastfeeding experience. Paediatric ST6 ‘oversupply’ a potential of which have adapted with telephone and On returning to work I am hyper-aware of the Wirral Women and Children’s issue, but by week three online support during the current times. significant emotional impact of breastfeeding Hospital my substantial supply difficulties. I now take more time talking led to forceful let-downs. y baby latched to families whose babies present with early My daughter now struggled to hold her latch, M beautifully feeding problems, carefully considering coughing, spluttering and screaming through and by day five had the mothers’ wishes, feelings and support unsettled feeds. regained her birth available and working with them to devise a My mind jumped to medical diagnoses; weight – fantastic! But safe and manageable feeding plan. reflux, cow’s milk protein allergy etc. by two weeks she was However, none were the case and with Dr Jenny losing weight, vomiting reastfeeding excellent peer support to suggest technique Lemon frequently and at four Bmy first didn’t and position changes, share experiences and Paediatric ST6 weeks she virtually come naturally but I Warrington and coping strategies, I persevered. If only all Halton Hospitals stopped latching. was incredibly well mothers could have this support, as by week NHS Trust Realising I had an supported by my family, six my supply regulated, my daughter found under-supply, I spent friends and community her groove and feeding became much easier. the following few weeks on an unsustainable Dr Rebecca breastfeeding team With peer support for breastfeeding regime of breastfeeding, bottle feeding (mostly Clements and I breastfed my women restricted by the pandemic, formula) and then expressing, leaving little Paediatric ST4 daughter for two years, paediatricians are even more likely to be time for anything else. Following a tongue-tie Alder Hey having only aimed for Children’s NHS an early contact for those experiencing release, she remained frustrated at the breast, Foundation Trust six months! I realised breastfeeding difficulties. The ability to take so I focused on expressing, supplementing the @doctormumbec breastfeeding was a a good breastfeeding history and support deficit in my milk production with formula, a massive gap in my or refer mothers with breastfeeding issues regime I sustained until 10 months of age. paediatric knowledge base, so I began to research evidence-based lactation resources and trained as a volunteer peer supporter Key points – a role I love. I discovered physiology and Recognise the critical early weeks for expressing to top-up but support is management options I’d never heard of! I’m establishing breastmilk supply. needed to do this alongside direct currently breastfeeding my second daughter Breastfeeding diffi culties can feeding. with much more knowledge on board and far present with similar symptoms Breastfeeding diffi culties can be fewer challenges. to medical diagnoses – include a highly emotive. Sensitivity is key. breastfeeding assessment. With good and timely support, many Resources which have been invaluable to me Under supply and poor milk transfer breastfeeding diffi culties can be include the Hospital Infant Feeding Network can be treated in the short term by solved or even avoided. website, protocols from the Academy of Breastfeeding Medicine and peer support from RCPCH position statement on breastfeeding www.rcpch.ac.uk/breastfeeding the Breastfeeding for Doctors Facebook page.

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The Synapse Centre for

Dr Ben Marlow Neurodevelopment Consultant Paediatrician and Clinical Director Dr Ben Marlow talks about the inspiration behind setting The Synapse Centre for Neurodevelopment up The Synapse Centre and what he hopes to achieve ESNEFT

HE SYNAPSE CENTRE for The Synapse Centre vision Ben’s daughter Evie and Neurodevelopment ESNEFT (below) Ben with his Database; the centre aims to establish a T (East Suffolk and North Essex son Freddie ground-breaking database that seeks to NHS Foundation Trust) is a new research combine data from a variety of platforms: centre based in the East of England looking social care, education, primary care and to translate biomedical research into secondary care. Many children we see practical therapies for local children and have ‘umbrella’ diagnoses of autism or their families with neurodevelopmental learning impairment that don’t truly reflect difficulties. the underlying behavioural of biological It will harness the collective skills phenotype. of a range of professionals including Addressing comorbidities; many clinicians, speech and language therapists, children with neuro-disabling conditions physiotherapists and clinical psychologists. experience a host of medical co-morbidities: It will look to innovate and draw on new gastrointestinal issues, sleep disturbance, technologies and partnerships in research. seizures and pain. All of these impact on the quality of life of the child and their families, Inspiration behind the but also their ability to learn and develop. Synapse Centre Better recognition of these co-morbidities Working as a paediatrician in is central to the work of the centre and neurodevelopment, I have designed and how they can be addressed and treated to created the Synapse Centre driven by improve quality of life and life expectancy. personal interest and circumstance. New areas of research; understanding My son Freddie is six years old. He has the roles of the microbiome, immune system been diagnosed with severe autism and and genetics in neurodevelopment give the learning impairment, along with many potential to provide exciting breakthroughs comorbidities that impair his development. in this field over the coming years. Not sleeping, suffering with abdominal pain, drives this project to better prioritise, Family lead; the centre has a core focus immune problems and sensory processing fund and research a clinical area that group of families and children from a variety difficulties means learning and development consistently gets pushed to the side. It has of neurodisabling conditions. Their lived for him is very difficult. taken me approximately three years to experience is vital to better understand He is the inspiration for this centre and to set the centre up and establish links with and dictate themes of research. Monthly raise awareness surrounding the importance researchers from across the UK and the meetings will define research objectives and of early intervention, collaboration and rest of the world with similar aims and allow families and young people to be part of trying to correlate behavioural and interests. I have been enabled to pursue this research decision making. biological impairments to have a more interest through support by ESNEFT and a Education; to transform and invigorate personalised approach to generalised ‘Greenshoots Award’ awarded through the this area of medicine is reliant on the ‘up ‘umbrella’ diagnoses. NIHR to take some time in my week away and coming’ generation of doctors. Monthly My experience as a doctor and parent from clinical medicine. external speakers from the UK and abroad, coupled with monthly journal clubs will The Synapse Centre is keen to collaborate with anyone who shares our vision. raise questions, critically appraise research Visit www.synapsecentre.co.uk and combine interests and opinions.

Milestones AUTUMN 2021 19 FEATURE

COVID-19 in Ebola’s well- trodden path We hear from Dr Bethany Bryant on her experience of working in Liberia, fi rst during the Ebola crisis, followed by the global pandemic of COVID-19

ITTLE PREPARES hours, the systems in place from Ebola were reduced, and a flurry of patients returned, YOU for the reintroduced. sicker than before. Mums shared their fears L helplessness of Soon, many healthcare workers were learnt from Ebola, a time when loved ones seeing families choosing rapidly considered exposed or high risk. never returned, too scared to take that risk. to walk away from Hospitals closed as staff isolated. During Some clutched at strands of hair, the story healthcare, too afraid Ebola we learnt many deaths resulted from of its protection, carried as charms. People Dr Bethany of the cost. The cost of the impact on strained health systems and profiting from fears. Bryant treatment and cost of fear around seeking healthcare. We had to Many will be left broken, unable to cope ST1 Paediatric a day’s work lost. The prioritise keeping hospitals open and staffed with the work that once revived them. Trainee Morriston Hospital, Elwa Hospital, where I during the coming weeks. Locally and globally, we admire colleagues, Swansea arrived in January 2019, With few places left to maintain maternity friends and families who will be facing extra @BBryant6465 provided the site for the services, Elwa became overwhelmed with challenges with waned strength and limited country’s first Ebola mums and babies. Many didn’t make it, only resources. In Liberia, many have stepped up treatment centre. Healthcare workers have to the Emergency Department, too hot from to work in riskier environments and despite been operating in a system of constant long journeys of the dry season, some cold, worries, and the harsh rejection they knew crises or recovery for decades. Nurses still, others jerking, unresponsive to the they would meet. Some were refused entry were managing the stresses of trauma from phenobarbitone, no options for escalation. into marketplaces, rumours spread, and times of war and Ebola whilst having to Many children couldn’t access the they survived only through the kindness of constantly work in inadequate systems to malnutrition clinic due to extra strains of their strangers. No clap encouraged these workers. provide quality patient care. family’s life, including increased transport Attitudes of apathy, I am certain we’d all costs to maintain social distancing. Some be susceptible to when faced with burnout. communities restricted movement of people in Trying to cope in overstretched systems with and out. Only the sickest children were able to increasing demands, staff were losing hope. pass through road blocks. The children’s ward May 2019 was the beginning of a pilot filled with neonates with respiratory distress, programme to address some of the issues tetanus and severely malnourished children. and improve access to healthcare for the We considered bringing supplies to the main most vulnerable children in the community. villages we knew clusters of these patients Through training, mentoring and provision of were, but what if a community became basic medicines, we began to see results. infected following our visit? We did not want Then came COVID-19. Having barely taken to lose trust. After all, we came from the first a breath of recovery following Ebola, worries hospital in Liberia with a COVID-19 positive pounding through everyone’s mind, hundreds death and riots followed. of memories that haunted them daily. Within Some weeks passed, the stricter limits

20 AUTUMN 2021 Milestones COVID 19 FEATURE

What’s it like to work from home as a shielding trainee? A trainee and her supervisor share their experiences of the positives and challenges of a remote role

EWIND BACK unpredictability. In paediatrics there’s always A SUPERVISOR’S TO March 2020. going to be a level of risk – children are R Along with 1.5 prone to viruses, particularly pre-schoolers. PERSPECTIVE million others, I received I think we need to manage the risk by being THANK HEAVENS notification of my new adaptable, for example when COVID-19 FOR technology! status, of Clinically case numbers increase to think about I could get to know Dr Sophie Extremely Vulnerable redeployment to more COVID secure areas. my trainee and we Jackson (CEV) to complications One of the main things I’ve learnt from were able to touch ST1 Paediatric from COVID-19. shielding is the amount of curriculum that base regularly. Trainee Dr Alex Community Government guidance can be covered from remote working, both This helped with Children’s Health advised shielding with in terms of non-clinical skills but also doing Powell signposting and Partnership immediate effect. As virtual clinics/ward rounds/handovers. The Consultant ensuring they had @DrSophieJackson Paediatrician colleagues were preparing other thing I’ve learnt is to volunteer for any support for their Musgrove Park for the toughest period of their working projects that your department is undertaking. Hospital wellbeing. lives, I was contemplating an indefinite This is a great way to show enthusiasm and @A_Powell_ There were initial interval spent indoors. From the positives to ensure you have a variety of work to keep FRCPCH diffi culties with the challenges, here’s what I wish I’d known you busy. In terms of protecting and valuing accessing various starting out on this journey. people with health conditions, hybrid working patient systems/platforms. A I focused on education, creating a paediatric is an option to consider in future, with trainee wants to feel valued emergencies handbook, whilst formalising face-to-face work alongside remote working and have a sense of purpose. my teaching competency in a postgraduate time. Doctors who have been shielding have This, combined with drastically certificate in clinical education. I was able to proven that remote working can be productive reduced acute work, meant there contribute to patient care through managing both through contributing to teams but also was little ‘useful’ for a trainee to outstanding inpatient results, updating clinical individual professional development. do remotely. However, with virtual guidelines and assisting with editing of a handovers, the trainee gained patient and parent information pack. I joined exposure to some acute inpatient the RCPCH Equality, Diversity and Inclusion presentations. We established Member Reference Group, which enabled me weekly virtual clinics to join, to develop leadership and management skills. moving onto joining face-to-face I wanted to maintain some clinical contact, so clinics remotely (patients seemed with an inclusive and creative consultant team unfazed by having a doctor on I joined outpatient clinics virtually. screen as well as in the fl esh). For wellbeing, I found peer support through Remote in-house training enabled a senior mentor, colleagues and other shielding daily teaching from home. doctors invaluable through shared experience. Overall, I really enjoyed this Regular chats and check-ins with friends supervision. It was a pleasure provided that much needed social interaction. to see the trainee fl ourish and to witness how many useful FINAL THOUGHTS experiences were achievable If we’ve learnt anything over the course of remotely that could be linked to this pandemic, it’s to live with uncertainty/ the curriculum.

Milestones AUTUMN 2021 21 KEEP IN TOUCH We’d love to hear from you, get in touch through our channels Twitter @RCPCHTweets Facebook @RCPCH The latest member news and views Instagram @RCPCH [email protected]

HISTORY HISTORY TAKING: DR OTTO WOLFF

I’D DECIDED TO reward myself and read Milestones outside this summer. A cup of coffee, some of Ash’s Mentees Dr Andrew Tester, Dr Calum McPherson, mentors Dr Joanne Stirling, Dr Gillian Campbell, delicious baked goods and mentee and mentor Dr Nathasha Basheer and my Zero Day playlist form mentor Dr Lynsey Johnston the perfect backdrop. Unfortunately, I got distracted. A banging MENTORING song came on and I belted out the chorus with a mouthful of lemon drizzle. As I picked RCPCH endorsed up my magazine, it struck me that I’d found my tenuous segue into my chosen historical mentoring programme paediatrician instead. Released in 1982, the song may have been FOLLOWING THE We have also designed a CPD dedicated to the retirement of a giant of the late SUCCESS of our programme, with peer-supported 20th century paediatric world. Otto Wolff was paediatric mentoring learning workshops. Our CPD born in Hamburg to a British GP but came to the programme in the programme covers important topics UK when he was 16. He studied at Cambridge West of Scotland we including supporting the trainee with alongside his brother, graduating in 1943. His ‘F2’ have been sharing our difficulties, peer support, wellbeing and job was in Italy, guarding a POW camp where he journey to encourage human factors. We are delighted to have successfully delegated care of sick patients back Dr Natalie Bee other regions to start built a community of over 100 people to their families, which seems like a very good Paediatric Emergency Medicine a similar rewarding with 45 mentees matched with mentors. plan on a busy shift. Consultant initiative. We created Back in the UK, he decided paediatrics was Royal Hospital for Children, Glasgow a programme TIPS FOR SUCCESS for him and trained in Birmingham, starting an inclusive for anyone Recruit enthusiastic, motivated and academic track that would lead to the discovery in a paediatric post beyond foundation inspiring mentors for your community. of Abetalipoproteinaemia (why not Wolff level, with the programme design being Engage your target audience from the syndrome?), the identifi cation of the trisomy underpinned by the RCPCH mentoring outset i.e. a survey to potential mentees. causing Edwards' syndrome and designed a standards. Designing your programme Produce a robust training programme special diet for babies with Phenylketonuria. All around these standards gives the with additional resources for mentees whilst he was in training. Show-off. programme a structure. and mentors to feel empowered. He then moved to work at a We created our own training Utilise peer supportive learning – little cottage hospital in Great programme for mentors and mentees learn from each other with group Ormond Street, London. Under consisting of online modules, recorded workshops. his guidance, the institution grew lectures and virtual Q&A sessions. Create a continuous professional slightly and some of you may Following completion of the training, development programme for ongoing know it. He retired with a bevy of mentees were then matched with shared learning. accolades and awards, but I think Dr Richard mentors. Mentors are level 2/3 trainees, Use feedback to adapt and make his most interesting achievement Daniels associate specialists and consultants. positive changes to your programme. was creating the fi rst obesity clinic ST5 Paediatrics/ Neonatology for children. For further information on mentoring support visit Barnet Hospital Which is why he deserved the www.rcpch.ac.uk/mentoring-support @ccdaniels65 song, Hungry Like the Wolff.

22 AUTUMN 2021 Milestones MIKE’S SLEEP TIPS A hot bath or shower just before MEMBERS bedtime can help encourage sleep onset See page 28 Melanie with her ITU team at the Croydon adult ITU garden

ASPIRING PAEDIATRICIANS TEDDY BEAR HOSPITAL

THE TEDDY BEAR TRAINEES HOSPITAL TBH is A PAEDIATRICIAN a community health education project WORKING IN for primary school ADULT ITU children run by Lily Marrable medical students. I RECENTLY UNDERTOOK a state! Fast Atrial Fibrillation! 4th Year Medical It aims to reduce placement with the Croydon COVID-19 pneumonitis and its Student childhood anxiety University Hospital Adult ITU team. many complications! University of Nottingham about hospitals and Although a steep learning curve, I 5 Using unfamiliar drugs that are doctors and promote have learned a signifi cant amount not used routinely in paediatrics healthy living. A working with this incredible team, and having to think about secondary aim of the and refl ect on some differences anticoagulation considerations for society is to promote within adult ITU compared to my all patients! the specialty of previous PICU practice: 6 Adult clinicians use point of paediatrics to current 1 The patients are signifi cantly bigger care ultrasound (POCUS) far more medical students. This led to the and heavier! Assisting manually routinely for vascular access, creation of TBH Nottingham’s first ever handling and proning patients safely echo and lung assessments and paediatric conference. requires due consideration and real diagnostics. The programme, hosted virtually, physical effort. 7 Increased requirement for central consisted of exciting and informative 2 Encountering a greater deal of venous and arterial line placement talks from 10 guest speakers, including mortality amongst adults, having – also their vessels are much bigger consultant paediatricians of various frequent discussions around than children. sub-specialties, a paediatric trainee, resuscitation status and having to 8 The routine placement of a speech and language therapist, develop a broader understanding of percutaneous tracheostomies and three medical students who had end of life care. especially during the COVID-19 era, completed research in child health. 3 In light of the pandemic, which are done by the adult ITU We learnt about paediatrics as a having increasingly emotionally team on the unit. career, global child health and how to challenging discussions with Following this job, I have gained communicate with children with Down patients’ families as they cannot an appreciation for the value of Syndrome. physically visit their loved ones in POCUS and will try to weave this We had around 100 delegates from COVID-19 ITU. into my paediatric practice. I will first year medical students to FY1 level. 4 Having to think certainly miss the adults sitting For an online conference starting early about typical adult still for cannulas, and even arterial on a Saturday morning and lasting over presentations: and central lines, not needing seven hours, we were thrilled with the Ischaemic heart singing, bubbles or cartoon turnout! We want to continue inspiring disease! Pulmonary distractions! Finally, I really believe the next generation of paediatricians Dr Melanie embolism! as paediatricians, our training can and are already excited to make our Ranaweera Decompensated make us versatile clinicians, with next conference bigger and better! Paediatric Regis- alcoholic solid general medical knowledge, trar ST5 liver disease! practical and communication skills Croydon Hospital Hyperosmolar that can allow us to be valuable @mellamellaran hyperglycaemic within the adult ITU setting.

Milestones AUTUMN 2021 23 MEMBERS STARTER FOR TEN

We put 10 questions to a paediatric registrar and a consultant to see what makes them tick

Supervisor Trainee Dr Madeleine Rooney Dr Diarmuid McLaughlin Senior Lecturer Queen’s University Belfast Paediatric Rheumatology Registrar, Musgrave and Consultant in Paediatric and Adolescent Park Hospital, Belfast Rheumatology, Belfast Hospital Trust RCPCH Trainee Network Northern Ireland @mmerooney Representative @diarmclaughlin 1) Describe your job in three words. Children, joints, living. 1) Describe your job in three words. 2) After a hard day at work, what is your guilty Interesting, challenging, rewarding. pleasure? 2) After a hard day at work, what is your guilty A glass of wine. pleasure? 3) What two things do you find particularly challenging? Too many crisps to mention. Childhood chronic pain and waiting lists. 3) What two things do you find particularly 4) What is the best part of your working day? challenging? Seeing a child respond to treatment. Confrontation – not something I’m keen on. 5) What is the one piece of advice you wish you could Mastering joint ultrasounds to Dr Rooney's high impart to yourself as a junior trainee? standards! You won’t have all the answers! 4) What is the best part of your working day? 6) Who is the best fictional character of all time, Walking away at the end of the day knowing that you’ve and why? done your very best. Santa, makes childhood and adulthood magical. 5) What is the best advice you have received as 7) What three medications would you like with you a trainee? if you were marooned on a desert island filled with Work hard, work as a team and have a laugh. paediatric patients? 6) Who is the best fictional character of all time, Antibiotic, steroid, ibuprofen. and why? 8) If you were bitten by a Paddington Bear – for his determination, bravery and radioactive gerbil, what would good taste (marmalade). you like your superpower to be, 7) What three medications would you like with you and why? if you were marooned on a desert island filled with Persistence; it gets you everywhere. paediatric patients? 9) What is the single, most Ibuprofen, prednisolone and co-amoxiclav. encouraging thing that one of 8) If you were bitten by a radioactive gerbil, what would your colleagues can do to make you like your superpower to be, and why? your day? Pause time – for all those great life events. Be supportive. 9) What is the single, most encouraging thing that one 10) How do you think you, of your colleagues can do to make your day? your colleagues and current Take the time to teach by motivating and encouraging trainees can inspire the next learning. It can really make a difference. generation of paediatricians? 10) How do you think you and your colleagues can Nothing comes close to watching inspire the next generation of paediatricians? your patients grow up into By providing insight into the best specialty (and sub- healthy, happy and productive specialty) – we’re a friendly, enthusiastic bunch! young adults.

KEEP IN TOUCH @RCPCHTweets @RCPCH @RCPCH [email protected]

24 AUTUMN 2021 Milestones MIKE’S SLEEP TIPS Make your bedroom as quiet, MEMBERS dark and comfortable as possible See page 28

VIRTUAL EVENTS

Dr Ashish Patel TIPS FOR ARRANGING ST6 General Paediatrics & Sim A VIRTUAL EVENT Fellow Birmingham AS THE NUMBER OF digital learning events Children’s Hospital increases (clearly the need is still there) I have @DrKidneyAsh compiled my key tips for putting on your own virtual event. Last year when the London School of Paediatrics Annual Conference was cancelled, we set about transforming the event to a digital BAKING format and learnt countless lessons on the way. ATTEND A VIRTUAL CONFERENCE BEFOREHAND: You’ll get a feel for what works Ash’s Baking School and what doesn’t, as well as which sessions translate to a virtual forum. It also highlights WELCOME BACK TO another CHAI SPICED SUGAR COOKIES common technical pitfalls to avoid. masterclass at Ash’s baking school! Ingredients CHOOSE SOFTWARE CAREFULLY: A lot on the Now you have mastered muffins and 345g plain flour market, and most charge for premium features. All a tiered cake, the logical next bake 1 teaspoon bicarbonate soda provide slightly different features. Do consider how was bound to be cookies. Cookies are ½ teaspoon baking powder much a package costs, or if any grants are available an easy but rewarding bake, you can ½ teaspoon salt when deciding if you’re charging attendees a fee. essentially combine all the ingredients 220g granulated sugar TECHNICAL DIFFICULTIES: There will in one bowl. I love having one (or five!) 2 teaspoons ground cinnamon undoubtedly be issues on the day. Have someone with a cup of tea or coffee, and you can 1 teaspoon ground ginger on hand to troubleshoot and provide IT support, as play around with the flavours to make 1 teaspoon ground cardamom well as easing the host’s nerves. some delicious treats for your teams. ½ teaspoon masala chai COMMUNICATION IS KEY: You may never These chai spiced sugar cookies are a ¼ teaspoon ground black meet your speakers face to face, so clear, well- firm favourite of my Indian mother. pepper worded emails are crucial. Be specifi c! This They combine my love of masala chai 125g unsalted butter (soft) goes for technical instructions too. Delegate with baking and take me right back 1 egg communication should also be considered – to my village in India. Enjoy and ½ teaspoon vanilla extract a clear, eye-catching programme needs to be continue to spread the love of baking! distributed ahead of time. CONTINGENCY: Have a plan B, in case of Instructions combined and the mixture looks diffi culties, poor connection or tardiness. This 1. Preheat your oven to 180°C and light and fluffy. includes a back-up facilitator, programme and line two baking trays with baking 5. Next beat in the egg and vanilla device if necessary. paper. extract until combined. INTERNET CONNECTION: Organisers and 2. In a large bowl sift together 6. Add the flour mixture and speakers. Enough said. the plain flour, bicarbonate soda, combine together to form a cookie ZOOM FATIGUE: Beware! Schedule baking powder and salt, and place dough. short sessions with regular breaks. to one side. 7. Create balls of dough and coat in Encourage people to get up and 3. In another bowl combine the sugar spice and place on your lined stretch their legs. Keep sessions sugar, cinnamon, ginger, cardamom, baking trays – you can make roughly varied to spark interest, and masala chai and black pepper. 24 cookies, or fewer if you want them interactive to stimulate engagement. Remove 30g of this sugar mix to roll to be slightly bigger. Sprinkle some Dr Andrew FEEDBACK: Be creative in how you Chapman the cookie dough balls in later. sugar spice on top. ask for it and get it out promptly. Paediatric ST4 4. Add the softened butter to the 8. Bake for roughly 8-10 minutes. Northwick Park Link to a URL or QR code whilst you sugar spice mix and beat until Leave to cool completely. Hospital have your delegates' attention.

Milestones AUTUMN 2021 25 MEMBERS BOOK THE GIRAFFE, AND THE PELLY AND ME BOOK by Roald Dahl

BROKEN BRAIN: BRUTALLY THE STORY IS about four HONEST, BRUTALLY ME By Aria Nikjooy characters, a boy called Billy, a Pelly (a pelican), giraffe, and a ARIA NIKJOOY WAS There are times when his monkey. They all have to clean working as a paediatric anger and frustration are lots of windows for the Duke as trainee when he received palpable. However, there they have spent all their money the devastating diagnosis is also humour; Aria has a on buying a house and they of Grade IV Cerebellar knack for picking up the Sophia needed money to eat. When Aged 8 Medulloblastoma. This comedy even in his darkest they get to the Duke’s house, Dr Francesca memoir is an exploration moments. Powerful the Pelly with the boy in his mouth end up picking Long of his journey from initial imagery is present berries for him. I thought the sad bit was when the ST5 Paediatrics diagnosis and treatment, to throughout the book, not Pelly got shot in the beak and the Pelly became really Tameside General subsequent recurrences of just regarding his surgery sad. The Duke said, “No worries Pelly, we can fi x that.” Hospital the tumour and his death. and chemotherapy, but in I liked the ending the most because it was quite Aria does not shy away the quiet way he describes cheerful compared to what had happened to the from the painful aspects of his love for his wife and son. Pelly. I would give the book ten out of ten, because I his diagnosis; the physical I would thoroughly thought it was funny and I enjoyed the rhymes. effects on a young man, recommend this memoir the impact on his wife to all my colleagues, not and young son, and his only as an opportunity to re- APP desperation to return to examine their views on their the job that he loved. It own mortality but, as Aria HEEADSSS app.heeadsss.uk is raw, honest and not states, to “remember the always an easy read. person behind the patient”. THE HEEADSSS APP provides adolescent psychosocial screening and resource BOOK signposting to young people from 10-24. HEEADSSS (Home, THE SLEEPING BEAUTIES: AND Education/Employment, Eating, Activities, Drugs, Sex, OTHER STORIES OF MYSTERY ILLNESS Dr David James Suicide prevention, Safety) is by Suzanne O’Sullivan Consultant Paediatric an internationally used tool DESPAIR AWAITS HOPE explains how mental Emergency Medicine to screen young people for Southampton as a princess lies still. What illnesses requires more Children’s Hospital potential risk and preventable poisoned fruit has she than a look within. Many @drdavejames harm. We developed the app bitten into and is there a answers in fact reside locally in Wessex to provide way out of the sleep that outside – be it the venom a bridge between asking screening questions and engulfs her? or the antidote. It is the providing resources which can be sent directly to the Dr Shilpa Shah Suzanne brings us very embodiment of young person by text or email. The database contains Consultant fascinating stories of culturally acquired illness national resources as well as local resources for each Paediatrician ‘mystery illnesses’ and templates that results region within the Wessex area, all mapped to individual Craigavon Area in doing so, unravels a in a behaviour pattern HEEADSSS domains. The app was initially funded by Hospital @drshilpashah profound truth – we are as eventually resulting in Health Education England with further funding from much an expression of our functional symptoms. Healthier Together, the National Academy for Social genes as we are a product Through this book she Prescribing and Arts Council England. It contains of our environment. In implores us to broaden sections for professional or parent led a sense we are biology our horizons – else screening as well as a self-screening section within a sociocultural sleeping beauties will for young people. We are keen to grow into phenomenon. As a lie asleep. Forever and other regions and are currently looking at the clinician herself she ever more. best way to achieve this.

26 AUTUMN 2021 Milestones Hashimy Azim Faizah Dr Authority (DHA) Authority Paediatric Residency Dubai Health Health Dubai Chief Resident, paediatrics. in specialising footsteps, my father’s in following doctor, and amedical becoming education, my higher ofpursuing goal the with here Icame 2009. in Afghanistan from the here moved Ifirst UAE since my home Ihave called adecade, Now than for more did. way my father same the world in the in adifference to make Iwanted that me to clear more and more it became witnessed, I visit patient every With visits. hospital afford could patients the not all as seeing clinic, the and hospital the in work hours his at after home patients those see often He would needed. they care the got patients his sure made and gentle, patients, his with provider: healthcare ideal ofan model the was My father Hashimy. Azim Mohammad my father, Dr from care and advice to seek home our visit would people when work was at apaediatrician seeing time myRather, first student. amedical as my years during even or years my intern not during was patients well. as programme training Yet the first place I encountered paediatric paediatric Iencountered place Yet first the the paediatric residency residency paediatric the Hospital. Later I joined Ijoined Later Hospital. Dubai and Hospital Latifa namely Hospitals, Authority Health Dubai in intern an became I which after 2017 in College Medical Dubai from Igraduated globe. the around of children wellbeing forcater the can that a paediatrician being means Emirates Arab United the in PAEDIATRICIAN A BEING Emirates means working with adiverse group of children Dr Faizah Azim Hashimy Faizah Azim Dr For he was generous Providing care for children children for care Providing from around the world the around from receive treatment, but the large number of of number large but the treatment, receive to ofpatients number for alarger not only allows capacity bed large facilities’ NICU The region. the in facilities NICU equipped well very ofthe one for having reputation hospitals DHA Additionally, (EHA). Authority Health Emirates the and (DHA) Authority Health Dubai the (HAAD), Authority-Abu Health Dhabi Prevention, and ofHealth Ministry the UAE including different regulatory authorities in the by administered are services healthcare Public level. Emirate and Federal the both the population. Healthcare is regulated at to ofhealthcare standard ahigh delivers that sector health private developing arapidly and service health funded a UAE comprehensive, has The government- sub-specialties. healthcare centres with different primary and hospitals, centres, tertiary as well as options, treatment latest the with equipped and modern are which facilities boasts a healthcare system with medical UAE the like; looks really infrastructure healthcare what developed first-hand Working here, I have been able to see able to see Ihave been working in the United Arab have a a have regardless of where they come from. from. come they ofwhere regardless humanity to serve adoctor: ofbeing aim main the to fulfil us enabling UAE, ofthe citizens to the addition in culture and religion, race, ofevery for patients care able to provide being means Working world. here of the centre the in working UAE like is the in apaediatrician as working that certainty say with Ican UAE, the in here professional amedical as Ihave spent time the Through globe. over the all from visitors and travellers in UAE so but more the in not common are which diseases infectious or diseases blood and syndromes as such families in run which disorders inherited it be conditions, of health avariety to see opportunity have the here doctors born, 50% of the UAE’s population being foreign- being UAE’sof the population Milestones Moreover, the future. for ofhope source amajor is children into healthy growing and unit the in stay of their course stormy the withstand to strength their neonates, premature ofthe growth training. Witnessing the our during of procedures differentperform types and neonates ill of critically to engage in management chance the us gives admissions with more than than more with AUTUMN 2021 2021 AUTUMN 27 INTERNATIONAL 28 WELLBEING AUTUMN 2021 2021 AUTUMN Dr MikeDr Farquhar Children’s Hospital Medicine Paediatric Sleep The quest for meaningful sleep meaningful for quest The Evelina London Consultant, @DrMikeFarquhar Dr Mike Farquhar Dr and highlights the conditions that have led to excess pressures Milestones I these simply aren’t sufficient. Families Families sufficient. aren’t simply these particularly those with complex needs, but for some, perfectly followed be properly”. done “not being are principles these because it’s always sleep, have poor children if that think who those by misunderstood be often can This change. to effect interventions behavioural by supported often habits, and routines ofgood foundation their children. to parent best the to be ability their maintain jobs and, fundamentally, to ability their health, mental and physical their it affects deprived, sleep chronically are carers and parents When family. the within problems far-reaching cause also but can health their impact can this need, they sleep differences. neurodevelopmental difficulties and and physical ofcomplex context the in disruption sleep significant on fumes…” running are now Many reserves. own their on drawing staff NHS has been filled by gap resource “The A harsh truth is that the ‘rules’ can can ‘rules’ the that is truth A harsh a on depends sleep Quality quality don’t the get children When families whose children have many we support Clinic, Sleep N OUR EVELINA Wellbeing explores the need for sleep, both for patients and staff, London London Committee, chaired by Jeremy Hunt, Hunt, Jeremy by chaired Committee, pandemic. the by caused weren’t and endemic, systemic, are though NHS work. daily ofour challenges the to face foundation individual best the them to give to try who work shifts, for those especially sleep, own their improve members helping on focused I’ve physician, asleep As issues. these consider deaneries and departments way the changing by and individually both support providing members, our after oflooking importance the emphasised COVID, before long years, for many has, RCPCH teams. own our about apply we think when alone. them by solved to be big too are problems anyone’s!) some –that fault (or their not to be for that and enough not to be for that all, their give can they that haven’t failed, to they know need families these all, Above input. carer or respite providing support, care social may need They batteries. own their to recharge time parents to give ofsedatives, consideration ground. to the to plummet about ofno return, point at the already they’re unaware mid-air in suspended edge, cliff over the already often become despondent, convinced they’ve they’ve convinced despondent, become Coyote in the the Coyote in E. Wile like are, they them meet first I when families For many them. affecting is deprivation sleep chronic how recognising not always failed, they’ve convinced despondent, become The Health and Social Care Care Social and Health The the in we face problems greatest The must principles same Those may need children These Roadrunner cartoons, whole NHS. We must be honest about We about honest whole be NHS. must the across normalised much very been often has now, that asituation years for many pressure immense have under put us that issues systemic massive for the to compensate enough be never will how fabulous, matter no alone, individuals on focused Solutions problem. the with to deal it isn’t sufficient itself by work is, that as needed and brilliant as that, is though truth brutal The staff. support work to done offantastic lots with pandemic, to the response NHS of the suffers.” care patient excessive, are workloads Where cope. to struggling already onto doctors responsibility more loading we are, way “We the on go simply can’t said, West Michael Professor co-author 2019, whose December published doctors, caring for patients for caring doctors, recently published a report that told us told us that areport published recently the GMC-commissioned GMC-commissioned the nation’s for health?”, the and care who for those cares “Who asked 2019, which February published Mental Wellbeing Commission, England Education Health the like reports earlier echoes Hunt’s report Self-care mid-air, haven’t realised it yet. it yet. mid-air, haven’t realised Coyote in E. Wile like but, fumes on running are Many reserves. own their on drawing staff NHS by filled been has created that gap resource the and for years, under-staffed chronically been has NHS –our know what we all told us that areport published recently ‘Wellbeing’ has been a cornerstone acornerstone been has ‘Wellbeing’ Caring for for Caring report, report, within shifts, and meaningful meaningful and shifts, within breaks and rest regular getting as such basics, ofthe importance need. they care for the longer even up waiting end will families and children and profession… the leave out and burn ill, become will now, more many right then staff our after we don’t looking if get that emphasise view, and longer the take we must support, and input our need who families and children and lists what we have. work with have to we will then Until time. take to going is that –and workforce NHS the in, investment of, and reform major we need Hunt, by stated As toBack basics their control. within not really are which reasons for deserve, they we know standards to the families their and patients our for able to deliver for not being failed, blaming themselves, thinking they’ve up end individuals otherwise this, We must emphasise the the We emphasise must waiting long we now face Where MIKE’S SLEEP TIPS write your ‘to do’ list list do’ your ‘to write for tomorrow – get –get tomorrow for it out of your head your head of out it Before bedtime, bedtime, Before before trying to trying before sleep our population’s health needs, we ofmeeting incapable currently is standard”. highest of the care to provide order in abilities and wellbeing health, own to“attend their that healthcare practitioners must us reminds ofGeneva Declaration public. the and families their patients, to our message that communicate better we must and individuals and departments… of ‘fault’ the isn’t necessarily that and enough, may not be that that all, our give individually we can NHS modern the in that to admit We ourselves allow must themselves. in solution acomplete aren’t they acknowledge we must foundation, essential ofan part form these while my clinic, in like but just hospitals, and departments by supported to be need These wellbeing. own their about think individuals help work to brilliant the all in value absolutely is There to recharge. work away from time regular In the context of a system that that ofasystem context the In WorldThe Association Medical responsibilities around this! this! around responsibilities individual own ofour block building but important asmall be to going always is nights most sleep patients. our and them of interests best the in themselves, after to look space and time needing for guilty to feel made not be must individuals that and Government, and organisations NHS employers, responsibility, borne primarily by akey professional is staff healthcare after looking that remember must Evelina London Sleep Clinic Links Useful Supporting report onSupporting report wellbeing lives: –Working 2040 Paediatrics work shift of effects the managing on Farquhar Mike Dr from Advice professionals health for wellbeing and breaks Sleep, … but yes, working to get good to good get working … but yes, paediatrics2040.rcpch.ac.uk ep.bmj.com/content/102/3/127 www.rcpch.ac.uk/sleep-breaks www.evelinalondon.nhs.uk/sleep Milestones AUTUMN 2021 2021 AUTUMN 29 WELLBEING A DAY IN THE LIFE

“Maybe one day I will inspire a mini-me!” Dr Stephanie McCallion ST5 Paediatric Intensive Care Medicine Royal Hospital for Children Glasgow @SteffiMcCallion

I became a paediatrician because some of my earliest memories were spent in Yorkhill Hospital in Glasgow. My sister spent a lot of time in hospital when I was younger, and I inadvertently did too. I used to walk up the big hill from Like many When I finish paediatricians, the bus stop with a 10p pick ‘n’ mix bag to visit her, and Stephanie loves cake! work I like to... after we had been to see her, my grandad would take me to carve out some time Kelvingrove Art Gallery. It was actually a very happy time for me. I’m really for my family when we spent lots of time together. I still My most memorable moment was diagnosing passionate about remember the moment I turned to the doctor looking after my biliary atresia in my first placement, and then wellbeing so I always sister to tell them I would be just like them when I was older. meeting the baby (who wasn’t such a baby any end my day with some It’s such a privilege to know you are living out your childhood more) at a gastro clinic. Her mum remembered yoga. Whether it’s 10 dream. Maybe one day I will inspire a mini-me too! my name and thanked me for pushing for an minutes, or 1.5 hours, ultrasound scan (she was only day two, so it was without it I can feel like My typical working day involves starting the day with a very early for me to suspect it, but I won’t forget my head is too busy to large, black coffee. Once I’ve had a coffee, I am usually ready that gut feeling I had). be present at home. to crack on. As with most jobs, the day starts with handover My two kids are fast- (if I’m lucky there might even be more coffee) and then on paced fi recrackers, with the ward round and jobs. I’m not that big into routine, so they don’t provide so I enjoy being in acute specialties because, although there much zen time. Yoga is structure, every day is different – and that’s what keeps it gives me space to exciting. recharge. The old saying ,“You can’t give The most difficult part of my job is leaving on time after from an empty cup”, is work has finished. I’m always grateful that my husband can true. I also like to read do the after school pick-up, but it is something I strive to get books and my favourite better at for my work-life balance. is The Remains of the Day by Kazuo Ishiguro. The best part of the job is getting to go to work with your Most importantly, I like friends. I think it’s lovely how the training programme to fi nish a week off creates such teamwork and some of my best friends are with something fancy people that I’ve trained and worked with. shaken over ice.

KEEP IN TOUCH @RCPCHTweets @RCPCH @RCPCH [email protected]

30 AUTUMN 2021 Milestones