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As the healthcare system prepared for a significant rise in Covid-19 cases, Dr Lucia Gannon reflects on the momentous efforts of staff and the importance of remaining hopeful
Every day, for the past week, I have attempted to write this article, and every day I have abandoned it. It is hard to believe that less than two weeks ago, people were going about their normal routines, going to work, school and taking holidays abroad.
Finding words to describe the dramatic changes in the world is difficult, and I am sure that by the time that you are reading this, what I describe here will be history and we will be facing a new set of challenges. A week is a long time in healthcare.
For now, I feel like a reporter from a war zone where we are quietly waiting for the enemy, bunkering down, checking our equipment, getting up to speed on war tactics, and forming alliances to help us overcome the inevitable attack.
Our days have become completely unpredictable, as directives change, hour by hour, while we work with what we know and try to stay informed. As GPs, our days have been filled with guidelines, algorithms, hand sanitisers and disinfectant wipes. Instead of patients, we have had locked doors and empty waiting rooms, the gleaming leather chairs lined up like question marks.
It’s been a time of telephone call-backs and if we are lucky, as of today, electronic referrals. It’s been a sharp learning curve as doctors have grappled with personal protective equipment (PPE), decontamination procedures, preparation of isolation rooms, repeat prescriptions and the usual major and minor illnesses.
Practice nurses, secretaries and administration staff have had to adapt to rapidly changing instructions and expectations, while remaining calm, minimising their own as well as others’ anxiety.
In the initial stages, the questions were about who to examine and who to test. Doctors screened the calls and grouped respiratory cases together at the end of surgery when they were examined with the doctor dressed in full PPE. This has changed rapidly to examining less and testing all who may be infected, the criteria getting lower each day. Worries about locums for holidays have paled to insignificance as we replenish stocks of palliative care medicines and prepare for increasing numbers of ill patients.
Video consultations and electronic prescribing, until now, strangled by GDPR regulations are back on the agenda with doctors doing their best to get them up and running.
General practitioners, hospital doctors, public health specialists, PCRS, HSE staff, have worked together around the clock and through the weekends to put practices and procedures in place, to share information, maximize care and support each other in this time of unprecedented uncertainty.
With their help most GPs have managed to respond and manage the tsunami of queries and demands. Despite social distancing, no doctor should have felt alone, isolated or unsupported. What this crisis has shown is that we are all part of a team of hard-working, resilient, compassionate, motivated and conscientious workers who respond rapidly, tolerate uncertainty and look out for each other.
It would not have been possible to manage these past weeks without this support which was evident in the many WhatsApp groups that sprang up for doctors. What could have been chaos became instead, a quiet sea of uncertainty, in which we were swimming rather than drowning. This quiet competence transmitted to patients who have remained mostly calm, in the face of the uncertainty that has gripped the world.
Lying awake at night, when all the unanswered questions threatened to overwhelm me, I turned to hope. Hope emerges when times are tough. It helps us overcome obstacles and forces us to put our resourcefulness into action. Hope builds resilience in the face of hardships. When we are hopeful, we envisage the outcome that we want-in this case, limiting the spread of infection and avoiding unnecessary deaths, until such a time as we have a vaccine or a cure- and work towards it.
Having a common goal helps us to act together towards attaining it. Acting towards our goal creates a sense of agency that displaces despair and helps us remain focused on our goal.
Attaining this goal is not just in the power of frontline staff or experts. It is the responsibility of every individual who has the capacity to understand what is happening. Explaining the importance of hand hygiene, cough etiquette and social distancing is just as important as providing frontline care. Every individual has agency, in this crisis and for those who feel fear, despair and hopelessness, it is particularly important that we remind them of this.
We will all need to practice hope in the coming weeks and months. Keeping our focus on the preferred outcome will help us take appropriate measures and stay positive while doing so.
With every best wish to all of you in these difficult times. May you remain safe and well and hopeful.