Catherine Labinjoh
Dr Catherine Labinjoh is a Fellow of the Royal College of Physicians of Edinburgh. Other positions within the College include Council Member representing the constituency of Central and Tayside, and member of the College’s Equality, Diversity, and Inclusivity Group. She is a Cardiologist and works in NHS Forth Valley Hospital.
This interview took place on 5 October 2020.
Details
- Date of interview: 5 October 2020
- Archive reference: RCP/RES/2/12/5
- Interviewer: Daisy Cunynghame
Timestamps
00:00 Introduction
00:49 The effect of coronavirus pandemic on working hours and practices
02:18 Comments on availability of medicines, medical equipment, and Personal Protective Equipment (PPE)
03:22 Complexities of treating patients during the coronavirus pandemic
08:12 Thoughts on the long-term effects of coronavirus on health and mental health
10:20 Long-term effects of the coronavirus pandemic on the NHS
14:03 Government response to the pandemic
16:05 Public response to the pandemic
19:02 Personal experiences of friends and colleagues contracting Coronavirus
21:43 Effect of the pandemic and lockdown on home-life routines
25:08 Wellbeing and mental health impact of the pandemic on medical professionals
27:33 Views on finding information surrounding the pandemic
29:30 Comments on the role of the College’s Equality, Diversity, and Inclusivity Group during the pandemic
32:56 Closing comments on how the pandemic has affected the use and sense of touch as a medical professional
Transcription
Interviewer:
Could you please start by just introducing yourself, your name, your membership status of the [Royal College of Physicians Edinburgh], and where you practice?
Catherine Labinjoh:
Yeah, my name is Catherine Labinjoh. I'm a fellow of the college and I'm also a council member; I represent the constituency of Central and Tayside. I've forgotten already what else you asked me to say.
Interviewer:
Your medical specialty.
Catherine Labinjoh:
Oh yeah, sorry, how could I forget? I'm a cardiologist and I work in NHS Forth Valley.
Interviewer:
Thank you very much. I'm going to start off by asking questions which relate to how coronavirus has impacted on your professional role. Could you describe how the coronavirus pandemic has affected your working hours and practices?
Catherine Labinjoh:
In terms of my working hours, I would not say they're particularly longer, but the way that I practice is quite different and this interview is an example of that. So, I have a headset and I'm looking at you on video and that's not something I did very routinely until March of this year. In terms of affecting how I interact with patients, the same is true. My patient contact has diminished considerably and I'm now dealing much more with patients on the telephone and occasionally using video conferencing.
How I deliver my work and where I deliver it has also changed. There's competition for space at work to be able to make these kinds of calls and interactions, so I sometimes find myself just finding any space anywhere. I might not necessarily be in a consulting room that I'm familiar with or in my own office. I might have to book a room elsewhere or find a corner of another place. I have for the first time been doing much, much more work from my own home, including clinical work, contacting patients and having consultations with patients from home. So that's really different.
Interviewer:
Have you experienced any shortages of medicines or medical equipment in your work, or do you have any comments on shortages you've heard about more generally?
Catherine Labinjoh:
In my own area, shortages have been managed extremely well. We feel that we've been very well provisioned, for example, with things like PPE. Where there have been issues about supplies these have been managed very well, and we've had advanced warning of things changing. One example of that would be I was fitted for a special mask, the mask to protect us from COVID and it became apparent that the supplies of that mask were diminishing, but that was clear in advance. So, I had to go and be refitted for the new mask. I think there was quite a lot of thoughtfulness around, you know, advanced planning and the kind of supply chain, if you like, for things here. So, we haven't had very much in the way of shortages at all.
Interviewer:
Without naming or giving identifying information about individuals. Are you aware of any particular patients experiences which you could share with us, which illustrates some of the complexities of treating people under coronavirus and lockdown?
Catherine Labinjoh:
Gosh, that's interesting. Yes, I think in the early stages, particularly when we were in what we would call maybe the tightest, most intense part of lockdown. Not only was there a systematic change to how people received care., They didn't go, for example, to their GP (General Practitioner) or they didn't have face-to-face consultations, but there was also a massive fear factor about how to receive care. So, there were things that weren't available to patients, but there was also their reluctance to not avail themselves of the things that were available with the fear, for example, of meeting other people and coming to hospital. That led us to do things differently and one of the things that was really interesting about this era is that we were given permission to do things differently and we didn't ask so many questions around whether we were allowed to do things.
I mean, we were still safe, but a good example might be a patient who was at home complaining of breathlessness, someone with multiple comorbidities who was older and perhaps what might be considered in a higher risk group. Because of COVID, there was a fear of those patients coming, for example, to have a COVID test, even though they had a symptom of breathlessness. So, a team was enhanced within Forth Valley where those patients could be assessed by a general practitioner or a care of the elderly physician within their own homes. Because I'm a cardiologist, I sometimes see people who are breathless, not because of COVID, but because of heart failure and it became apparent that that team who were going out to assess older, more vulnerable people with potential symptoms of COVID actually were finding patients at home sitting with heart failure, too fearful to access the normal channels. That could have been a disaster, but in fact, we learned a lot from that, and some patient’s experiences were really enhanced in that they got a quick assessment in their own home. They were able to have treatment in their own home. The physician who was looking after them in their home was able to contact me for advice and we set up a [Microsoft Teams] group where we could do very quick, rapid turnaround, what you might call case discussions or MDTs. I could give advice on treatment and where it became clear that that patient was more precarious at home, perhaps might require to come into hospital, again, we were trying to avoid that. We quickly set up an ability where we could give them some of the treatments that they required in hospital, for example, intravenous diuretics but on an outpatient basis. So, they came up, had the diuretic and went back to stay in their own home.
I know lots of the descriptions of care in this time are descriptions of care that's been less good. But that for me was an example of care that paradoxically was better, more person centred and was able to be delivered in a way either in the patient's home or in an ambulatory way where they could come in and out of their home. So that that was a positive experience to start with.
I think, on the other hand, in general, we noticed fewer patients coming to hospital with complaints, for example, of chest pain and we wondered where those patients have gone. Then more specifically, we recognised that there was, I would say, across the piece, quite a loss for patients in a number of areas. Many people felt that they lost the face-to-face contact that they would have had with the caregiver, particularly a nurse practitioner or a doctor. I recognised when I was telephoning people that that might have been the only contact that they'd had with anyone that week and they were keen to stay on the phone and chat and really to ask questions. Not so much about their health care, which was really diminished, but a lot of questions about the current state of affairs and about coronavirus and how to stay safe.
So that kind of encompasses the range of experience and to some extent. Other patients we know who were expecting treatments, things like bypass surgery or valve replacement surgery, they certainly had a hiatus in their treatment. But I would have to say that both the major centres that we deal with worked really hard to make sure that we quickly triage people around clinical need and those people who needed to go ahead and have their cardiac surgery still had it.
Interviewer:
Thank you. We're starting to hear more about the long-term effects of coronavirus on individuals. Do you have any thoughts on that, either specifically in the context of cardiology or what the long-term health effects might be more generally?
Catherine Labinjoh:
Well, that's making me smile because I'm thinking about people looking at this interview in the future as I sit here on the 5th of October 2020 and say, really, I've no idea. I mean, I don't know if anyone has any idea what the long-term effects of this virus will be. On the one hand, we're receiving a lot of reassurances about how, for the most part, people who are young and fit can have this long-term shake it off. We're being to some extent asked to categorise it a bit like the common cold. On the other hand, we see that people are affected by—it can be devastating in some people. We're definitely hearing that it's much longer to recover from than a common cold and there is this emergence of longer-term effects. The context of that's really difficult because these are people who've been ill during a pandemic and experienced isolation and perhaps lots of other social pressures and financial pressures, family pressures. We know that that in and of itself can cause long term consequences for people and their well-being. So how we're going to tease apart, if we really even should be trying to tease apart, the more physical from the more mental or psychological effects of being affected by this condition, I don't know. It seems likely because of the unique way that affects some of the systems, a bit more pronounced around clotting, some more cardiovascular effects, it seems likely that it's possible that there'll be long term effects in in some people. What we're hearing at the moment appears to be syndromes that are much more like the long-term effects of virus or viral type illness in general, rather than very organ specific things. I think we'll just need to watch this space.
Interviewer:
A similar question. In terms of the long-term effects on the NHS (National Health Service) and the provision of care, do you think that coronavirus will fundamentally change how things are funded, how things are structured in any way?
Catherine Labinjoh:
I don't think my working life will ever be the same again. I remember saying quite confidently, like a great forecaster, when people were talking about how the next four to six weeks were going to pan out, when we started having these conversations in the middle of March. I felt quite sage and wise saying, “Well, do you know what? I think we might be needing to think about something for six months”, and there were gasps around the room. It turns out I don't think I was so clever at all, because six months is a pretty conservative estimate for how long this is going to impact on us. It feels like there'll be a permanent change because there's no one untouched by this. The social and economic effects are so great and the impact of those things on people's lives and well-being and futures is going to be very great and as a health and well-being organisation, we're going to need to respond to that anyway.
In terms of how we practice, I hope that there'll be many good things that come out of it. People were, for the most part, collaborative in their approach. Lots of the barriers for working across different systems came down. They took quite a pragmatic approach and a lot of the time, I think people were very person-centred. People were happy to say to patients, “What do you need from us right now? We may not be able to provide it all”, and I hope that there's a long legacy of that. Some of the walls are beginning to come up again, the silos between, “Oh, we don't do that, or we do, et cetera, et cetera”. So that might be not a permanent effect, but I'm hoping that some of the good stuff, especially around innovation and change, will be maintained.
I think how we interact with each other as humans within the health system will be different. Our view of infectious diseases, how willing we are to touch hands, whether, you know, hold hands. How we occupy the same space with or without masks. I think the legacy of that will be really long and that's sad, that part of it. I think I will do so many more telephone consultations than I did before and, you know, it's kind of shaming realizing the people we dragged up that we didn't need to and how easy it is just to be stuck in an old-fashioned system. There'll be good things about that changing. Whether there'll be the blanket acceptance of video calling and video consultations, I don't know. There was a little bit of appetite for it amongst the cardiology patients at the beginning. Now, many more of them are saying they would prefer just to have a telephone call, they can't be bothered with the video part of it. So, we'll see. I'm not sure about that.
In terms of funding. I think, yes, in Scotland, certainly we're feeling that there's a real impetus to change the way that unscheduled care takes place. A deadline, in fact, for the end of this month for boards to look at how they're going to provision care for people in an unplanned way, really differently and radically and much more based within communities and so on. I'm sure that's going to have long term funding implications, too.
Interviewer:
Do you have any comments on how the government has responded to the pandemic, either the UK government or the Scottish government?
Catherine Labinjoh:
Gosh, yeah. Let’s look at the Scottish government first, healthcare, as you know, has devolved to the Scottish government. I felt well informed and well looked after and I felt that broadly there was a team of sensible people trying to do the right thing in a difficult situation, mostly driven by fact and information and data and some difficult decisions to be made. I thought the messaging was quite clear, particularly at the beginning for us and for patients, at a time that was moving quite quickly. I didn't get the same sense of that from the UK government, and I felt that the leadership, perhaps, UK-based could have been better and I'm not sure on what basis some of the decisions were made and I think I have less confidence and more cynicism in what happened Westminster-based. That said in an extremely difficult time and with these tensions of healthcare and the economy pulling each other apart down the middle. But yes, I think the messaging and leadership, for me, was clearer in Scotland and I felt less confident about that in England. And some of the things we saw and the behaviours we saw from our leaders were extremely disappointing, and that occurred both in Scotland and the wider UK.
Interviewer:
Thank you. You've touched on this a little bit already, but I wondered if you had anything more to say around how the public have responded to the pandemic? Whether following regulations or the responses you're getting from your patients around complying with regulations and social distancing and so on.
Catherine Labinjoh:
I've been completely gobsmacked about how absolutely, terrifically, amazing the general public have been. I think to try and communicate these concepts of public health to the general public when we have taken public health for granted for so long, we don't worry about how clean our water is, we don't worry that much about immunisation and so on. The things that keep us safe as big communities from a public health basis just go unnoticed. The general public don't go around saying that the public health measures are the most important thing about healthcare, they talk about access to [General Practitioners] and other services. So that was a really difficult thing to communicate quickly that this is not a personal condition, this is a community condition, and community has to behave really differently. I think people took that on board really brilliantly for the most part. Of course, there are people who didn't so, they're the headlines. Most people were very thoughtful, very caring about the impact on medical staff. Almost every call I had in the first few months wanted to make a special mention of how caring they were about what we were having to do in hospital and how thoughtful and thankful they were about that. So, I think people have responded very well.
Understandably as it gets personally tougher, it gets harder for people to respond as well as they might, and as it gets more confusing and the messaging gets more difficult and it goes on for longer, that's difficult. I suspect for some young people it was particularly hard, and I'm a mum of a couple of youngsters who, I think, have done pretty well, but it was a pretty tough time for them. I think they get a little bit of a hard time, but it was probably something that wasn't going to affect them personally. For young people to think very about the communities more widely and not in a very personal way, after all, we've all been there and done that, I think it was tricky. But for the most part, people I think have been extraordinary.
Interviewer:
Thank you. The next questions I'm going to ask are more personal than professional. Just a reminder that if there's anything that you don't want to answer, you're absolutely welcome to just say, “No, I'd rather not answer”. Don't feel pressured in any way. Have you had or do you know of any colleagues, friends, or family members, without naming anybody, who has a personal experience of contracting coronavirus? And if you're comfortable with it, could you describe that experience?
Catherine Labinjoh:
Well, I'm pleased to say that no immediate family members have been affected, and I feel blessed for that. I've had friends who've been affected, colleagues who work in healthcare and many of them experiencing an illness that was much worse, I think, than they'd expected. They're similar ages to me; they're middle age and perhaps in the group where it's not so easy to shrug it off. I think there was a lot of fear for them and concern and continues to be concerned about the future, but they have recovered. I also have a goddaughter who has recently started at university, she's a fresher. I spoke to her this week, and we chatted for a little while and she said, “Oh yeah, and by the way, I've got COVID”. I said, “Oh, okay”. She said, “Yeah, but I'm okay, I wasn't quite sure if I was just tired, I had had a few drinks, you know, we've got a few hangovers”, which made me smile a little bit. I wasn't sure that people were going to be partying and having hangovers in fresher’s week, but they are, silly me, of course they are. And she said, “But everyone's got it, I don't know anyone who doesn't have it here”, so that's the kind of other side of it, really. And she's not too concerned, her mum is very anxious about it, [but] she's not too concerned.
I have a friend who's frail and elderly father who lived in a nursing home, who suffered with dementia, caught COVID and died. That was interesting because, of course, it's desperately sad, and yet from my friend's point of view, she felt that he had a very poor and low quality of life. It wasn't surprising that he would be vulnerable to almost anything going, particularly this, and she didn't feel particularly aggrieved that he had been susceptible to this or succumbed to this condition. Recognizing that he was probably within the last six to 12 months of his life anyway, and his quality of life was not good. So that's really the range of experience of people that I know in my personal life who've been affected.
Interviewer:
Could you describe how your home life routines have been affected by lockdown and COVID?
Catherine Labinjoh:
Well, as soon as you say that I just have an image of my husband and I—we both work in healthcare—standing at the back door to our house in our underwear, because we did that a lot at the beginning. We had a very elaborate routine to allow us to come home because both our children came home too. So, that would be one thing, you know, clothes off at the back door, straight into the washing machine—the clothes—wiping down keys and bags, washing my bag, straight into the shower, not speaking to anyone. A very elaborate kind of disinfection routine. I don't do that now, although I do still wash my hands and I'm careful. You know, stories of people saying that you would bring COVID back home if you wore the same shoes, I bought new shoes. I bought scrubs, my own scrubs, because the demand was high, and that was quite nice because I could buy scrubs that actually fitted me rather than a lifetime of scrubs that are designed for men and don't fit me. There's my characteristic dig, unisex just means men, obviously. Anyway, I digress. There was that aspect of it, rituals around that.
But some other things that changed, two children at home, one studying online of a university and one working and they did they did very well and just get on with that. But a different pressure, you know, more food and shopping and cooking and more people to look after, so a little bit of extra social pressure there.
The weather was quite nice and I took the opportunity—my husband and I sometimes do lift sharing, and he often cycles—I cycled home much more than I had ever previously and started to do my commute differently. I used bike and train, and train services continue to run, although reduced and were beautifully quiet and great for people who wanted to use bicycles, so that was good. I didn't get to see my dad, he was in a shielding group, I would walk around to his because we walked everywhere. We walked so much in lockdown, it was nothing to walk for 45 minutes or an hour to visit someone and stand in the street and chat to him out of a window. So that was different, but actually in some ways quite nice, you know, doing things a little bit differently. That might be the biggest impact. [I was] very significantly affected by the restriction on travel. I've got a dog, I like to walk and I like to decompress from my work by walking somewhere where I don't see anyone else, so not being able to go to hills and mountains was really tough in terms of coping with the way that I would normally de-stress from work.
Interviewer:
Given what you've just said about your personal experiences and your work experiences, do you feel like mental health and stress related support for medical professionals is significant? Is there more of that needed as a result of the impact of COVID? Do you get the support that you feel that you need, essentially?
Catherine Labinjoh:
I did feel a bit unsupported, but it's difficult to know in that situation and even in other situations how to provide the best kind of support. We're lucky here, there was very quickly set up a sort of web-based support network, which is good. There's peer support here in Forth Valley for consultants. There's obviously that informal support that one has in the usual network at home. I think what I recognised that I found particularly difficult was just the lack of being able to have informal conversations with people, go out for coffee, do just small things which helped to contribute. I found the fact that many of the other people who you might be leaning on had their own pressures as well, so I was perhaps reluctant to seek out support, which might have been useful.
I do think culturally what we need to strive for is an acceptance that recognising your limits, recognising your own stresses, valuing yourself sufficiently to take breaks and time out and do all of those things is good and healthy and normal. And that one of the risks at the beginning of the kind of all hands-on deck mentality. I mean, I was volunteering to help to do everything and everywhere, you just wanted to do stuff and make a difference. One of the risks of that is that you just feel a bit trashed by it, you know, three or four months later. I was a bit guilty of that. Not that I was at the coalface or, you know, working for hours and hours on end, but just maybe not giving yourself enough gaps.
I think the other thing, I don't know if you're going to go on to mention it, I found myself really obsessing over the data. I've got about seven or eight different apps on my phone looking things up and every day I feel I had to track everything and know what was going on in the world. I think just the uncertainty of this condition and wanting to control it by understanding the data and so on. Eventually I had to get rid of all of that stuff because the information overload was really stressful. The social media thing was really stressful and I had to kind of distance myself from that as part of looking after my own mental health.
Interviewer:
Thank you. you’ve kind of almost already answered my next question.
Catherine Labinjoh:
I’ve stolen in your question.
Interviewer:
No, it's fine. But I will ask it anyway if there's anything else. My question was, where do you look for accurate information on the pandemic? And do you have any thoughts on the role of social media and the internet in forms of disseminating information? So essentially what you've already said, but if there's anything else.
Catherine Labinjoh:
Yeah, I thought the information available was pretty terrific. There was slight competitive medic stuff as usual, who's got access to the latest data and knows the most and we're all, “Are you in the Stanford group or are you in this?” I read The New York Times coronavirus update; I read The Financial Times. Neither of which are papers that I read normally for the COVID updates. I did that through their apps. I used the Scottish Government app, the UK app, Health Protection Scotland. I could probably still open half of them in there, actually. Less of Facebook, I don't use Instagram, but I did get some information from Twitter, and I often do get some information from that. So, on the whole, it was helpful to be able to access those things, but I think I just needed to manage it a bit better, to be honest.
Interviewer:
This is my final question for you, you're nearly free. You are part of the [Royal College of Physicians Edinburgh] Equality, Diversity and Inclusivity Group, and I wonder if the coronavirus pandemic has sparked any particular discussions in that group or any aspects of your work that you think are impacted by coronavirus in the context of that?
Catherine Labinjoh:
Yes. Well, one of the things that's been impacted by the college is that group's ability to meet, so that's one of the difficulties. In terms of those issues more broadly, I would say maybe two things. First of all, the Black Lives Matter issues came to the fore during one of the more intense parts of lockdown. I found that really impactful for me. I don't know if that was because I'm a person of colour or whether I suppose it just landed at a certain time. My children were at home, we had good discussions around that. It seemed there was a space to be able to have more conversations around that during lockdown—I don't know if that's a coincidence or not—and we talked about what as a family, what we might do and what contribution we would make. We also talked about that in the college, and that was helpful and interesting, it prompted some reading for me and thoughtfulness about wider issues of diversity. Of course, because of the way COVID affects BAME (Black, Asian, and Middle Eastern) individuals and just how important it was to recognise that and I think recognise the plight of individuals being different from diverse backgrounds was really interesting.
Then more widely, I would say, as is often the case, but you recognise that people who are seeking help or getting help or whom we're connected with are not always the patients with the greatest need. I think the inequalities related to access have really been exaggerated during this time. I'm not quite sure what we're going to do about it, but every meeting I go to, I try to talk about that. The people who were harder to reach before in the hardest to reach communities, whether that be because of whatever social barrier or another barrier there might be, those all seem to be much worse during COVID, and I think that continues to be a problem and will continue to be a problem. Obviously, poverty influences access through things like phones and computers and being able to get to wherever the latest community centre is or access healthcare if it's not being provided at your GP and all of those things just multiply up. I don't think as an equality and diversity group within the college, we've got a strategy that encompasses that yet, but that will definitely be on the agenda for the next meeting.
Interviewer:
Thank you very much. Essentially, we're done, but I just wanted to ask, is there anything that you haven't had the chance to say that you would like to share?
Catherine Labinjoh:
I made a few notes earlier—just a couple of words. But the only thing, I think we touched on it, but I'll just mention it because I've written it down, was touch. That thing about not touching people and how strange that is to be a healthcare provider and be discouraged or afraid or have your touch unwelcomed, which was sometimes the case, particularly in settings where people were very poorly or where either the patient themselves or their family member was very distressed. I am sure that they found that difficult, I definitely found that difficult and it really made me think a lot about what I get out of being a caregiver and sometimes you forget that the handshake or the warm touch that you give to someone is actually just as terrific for you in a difficult situation as it is for them. So just the importance of touch, I don't know what we're going to do about that going forwards, but I'm hoping we'll get a bit more of it back. It was fun being able to elbow bump octogenarians who embraced that, but in those really challenging situations where you just instinctively want to feel the power of touch, to not be able to do that or to be discouraged or feel awkward about it was really tough.