As it’s Halloween and National Pathology Week 2021 is coming up I thought I’d re-share my love of zombie movies plus a little activity if anyone is looking for a fun outbreak to run with colleagues or as part of outreach.
It’s Saturday morning and I’m spending my day watching zombie movies. There is a reason that I watch in the morning… I’m a complete scaredy-cat and so I don’t want to watch these before I go to sleep. Also, I don’t really like horror movies. Correction: I only like horror movies with plot, i.e. Get Out.
So, why am I spending Saturday exploring the world of zombie horror?
Three reasons:
Despite not liking horror movies as such, I’m intellectually obsessed with how infection is portrayed in them and debating whether the infectious cause would result in different types of zombies.
Nicola Baldwin and I, because of our shared obsession with the genre (albeit for different reasons), are going to create a new piece of work on zombies and infection for the Rise of the Resistance Festival (online 7th and 8th May 2021). I therefore need to do some homework.
My husband really really likes zombie movies: he is super-stoked that this is my weekend homework, rather than writing papers or analysing data
My friends and I talk about this so much as part of our ‘pub conversations’ that we honestly do have a zombie survival plan. So much so that one of my best friends included saving her husband ‘during the zombie apocalypse’ as part of her wedding vows. This may sound silly and, believe me, it is; But there is some interesting and philosophical stuff in here:
Where is the best place to run to (cities vs country)?
What would you do in the 1st 24 hours, 1st week, 1st month?
Who would you get to join your party? Why? What skills do you need?
Do you take people along for the ride because you like them, or does everyone have to have purpose?
What rules of society might you abandon for the sake of saving the human race, i.e. monogamy, patriarchy?
How much aid would you offer to strangers ‘Good of the Many’?
Would you opt to die as you or turn if infected? ‘Survival at any cost and in any form?’
What would your ‘rules’ be?
These questions are all about how we, as humans, would react to a zombie outbreak. However, the thing that really fascinates me is how the zombie might change based on the cause of the zombie infection.
There are real life instances where infection can result in behaviour change. As part of my interest in this, I created the activity at the bottom of the page called ‘Zombie Island’. It was one of the first public engagement activities I designed and ended up being turned into a live action takeover event in the city centre of Toronto, where visitors had to solve different clues and challenges in order to cure themselves before they became zombies. The activity in Toronto was called Zombie Rendezvous and the link to the booklet is below:
Zombie Island – How Will You Save your Tropical Island Home?
The first thing you need to do is design your zombie. Will it be due to:
A virus?
A bacteria
A fungus?
This decision will affect not only how your zombie transmits infection, but also how fast and easy/hard to kill it is.
How do infectious causes affect zombie characteristics?
Slide taken from Design You Zombie Activity (see downloads below)
Once you have your zombies designed you can then play the scenario. Each different type of zombie requires different infection control and public health decisions/prioritisation. Make the wrong choices and the zombies will reach the port or airport and get off your island to infect the outside world. They can also infect your food supply, take down your military, or cause mass point-source outbreaks if you fail to shut down public events. All decisions aren’t equal, so make your choice…+
In light of the news that came out yesterday linked to the withdrawal of the testing service in Wolverhampton, I think that this post from April still has relevance so I have decided to re-post.
Every tube is a person
This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.
Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.
This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme
Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.
How Did We Get Here and How Does the Testing System Work?
When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).
The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.
Tests in the UK are carried out through a number of different routes:
pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
pillar 2: swab testing for the wider population, as set out in government guidance.
pillar 3: serology testing to show if people have antibodies from having had COVID-19.
pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:
Accuracy and reliability of tests.
Getting the right supply of people, lab space, equipment and chemicals.
Logistics.
What Points Did the Panorama Programme Make?
The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.
The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).
The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.
Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:
Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:
establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
sustains high-quality employee performance.
In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.
The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?
Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?
It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.
Staffing and Training
Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.
Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.
This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.
Quality Monitoring
In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?
Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.
All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.
To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.
So Where Does that Leave Us?
Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.
These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.
As stated in the programme: ‘If we’d spent the money supporting the existing system we would have been better off’
That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!
As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.
Yesterday the NCL Education Partnership hosted our 4th annual (bar COVID-19 related 2020) Healthcare Science Education conference (#HCSEd). These meetings came about as way to encourage and support Healthcare Scientists to recognise themselves as educators, in the widest possible context, not linked to specific training schemes or disciplines. It’s something we continue to be passionate about and if you’d like to get involved in future events please drop either myself, Ant De Souza or Vicki Heath a message.
This years theme was innovation in education and ended up including a lot about how we innovate, not just in terms of the technology, but in terms of our approaches in working with trainees, teams, workforce and the public.
The day was chaired by the Vicky Nash who is an established leader within medical education and is a great supporter of the Healthcare Science workforce. (NB apologies for my poor photography skills, all the good ones are from Rabbit Hole Photography and when the other ones come through. I will swap them out)
Nicola Baldwin, playwright and screen writer, kicked off our first talk on ‘Public perceptions of Healthcare Scientists during the pandemic’
Her talk was about her experience both as a member of the public and someone who works with Healthcare Scientists about how that perception has changed over the course of the pandemic and what some of the drivers for that change has been.
She told the story of how at the start people were engaged and interested, they felt part of the narrative and then they began to get lost as part of the conversation. We (Healthcare Scientists) lost our place in the story in the same way that the general public lost their ability to engage in the conversation as it became politicised and increasingly focussed on strategy and technicalities.
As someone who has previously written for Holby City she discussed that one of the reasons Healthcare Scientists are not represented on TV in the same way that doctors and nurses frequently are, is that doctors and nurses are presented as flawed human beings. They get the tests and they ignore them or they react to crash calls for good or ill, and frequently lack the information they need to make decisions. They are effectively glorified members of the public and therefore fulfil that role within the narrative of connecting with the view. In medical drama the guest stories i.e. patients, are only there to challenge the flaws or impact on the regulars i.e. the cast. In reality Healthcare Scientists do not visibly battle but work hard to remove their flaws from the equation, and therefore leave their emotions at the door. They live in a data driven world where patients do not always get better and we all die. Because of this Healthcare Scientists do not obfuscate and do not hope for the best, but make evidence based decisions and work in a world of these facts and may therefore make less attractive heroes for fictionalised drama. In the real world the longer the pandemic has gone on the more that scientists have been seen as messengers of doom as they deliver fact, not necessarily a message of deliverance.
So how do wemove towards speaking the same language and engage?
The challenge outside of the Healthcare Science profession is that the pandemic has laid bare a lack of scientific literacy and connection between scientists and the public domain and has therefore left reservoirs of fear. Our most basic measures of literacy are to read and obey basic instructions. Above this level educationalists have said is the ability to read and engage with newspapers and other sources. Above even this is the ability to compare, digest and analyse in order to support meaningful engagement. The same thing is needed in terms of scientific literacy and engagement. Connections between science and the public are needed to enable people to navigate the space and literacy is required to support analysis and evaluation of the information is available. Sometimes the connection between the Healthcare Scientist workforce and the general public is limited by a culture emphasises teamwork and there is a lack of individual promotion. In many ways this is great but it is important to be out there and therefore some form of promotion is needed.
Public perceptions have been changeable and volatile, opportunities to explain that from early in the pandemic were missed and that has resulted in public scepticism. To change this engagement of Healthcare Scientists is key to ensure that scientific literacy and the best way to do this is to not be afraid to promote and make connections. You and your stories can change the world!
Dr Steve Cross, science communicator, talked about ‘Science and science communicators’
Following on really nicely from Nicola with her call to arms in terms of the need to start and be part of the conversation, Steve talks about the practical aspects and challenges of engaging as a science communicator.
The big challenge for UK science communication infrastructure is that is consumed by 13% of the population which mostly consists of white, wealthy, males, who are 35 – 50. This doesn’t reflect our population, patients or future workforce so how do we communicate outside of the 13%? Some of this stems from the official science communication structures, such as the media, believing that ‘The public love debates about genomics’.
As nobody has to engage you have to make it engaging? How do you make something that actually works rather than ticking a box?
So how do we go about thinking how we undertake engagement activity? A good place to start is using Design Theory.
Empathise with the audience – remember ‘the public does not exist’ they are vastly different. Think about who you are trying to reach and why
Define the problem – put in work to really understand what you are trying to address, what are the barriers, who are your stakeholders, what are the reasons why things haven’t work before and what have people already tried
Have ideas – have lots of ideas, sensible ideas, crazy ideas, out of the box ideas
Prototype – come up with lots of approaches to those ideas and try them out, be prepared to try loads of them and throw them away in order to refine the prototype
Test and evaluate – once you have a prototype make sure you continue to test and ensure you evaluate and improve
Dr Rowan Myron, associate professor of healthcare management, gave our keynote on ‘Qualitative data collection’
Rowan started out talking about the pros and cons of quantitative vs qualitative data: qualitative may not be generalisable but gives rich data set exploring how and why, whereas quantitative may enable extrapolation but may be less deep and doesn’t normally explore motivations.
Traditionally Healthcare Scientists are considered to be Positivists, believing that data should give answers and therefore leaning towards quantitative data collection. Professionals that work with qualitative data are often considered to have more of a constructivist approach, where each piece of learning develops from the last and therefore permits exploration of how and why that development occurs.
It is also possible to have a mixed methods approach where some aspects of the work lend themselves to a quantitative approach, with other project components lending themselves to a qualitative collection method i.e. where you may use surveys to explore underlying attitudes but relate it to comparative quantitative bench marks.
The best approach for facilitating these conversations can vary from free – semi structured – structured and the style of facilitation matters. Directive interventions may be appropriate in some clinical meetings but is less likely to be successful in terms of gaining information and insights in a qualitative research setting.
Being in the room can sometimes change what people tell you – as a qualitative researcher you can get some of the best responses when you turn the data recorder off and so how you record and capture some of that which doesn’t fit into your framework, however it is important to consider the ethics of this. It is also key to ensure that you are recording accurately and not interpreting, and therefore checking in with participants to ensure that recordings are accurate is key.
Using some of these techniques can also help in non-research settings, such as team meetings and 1:1 in order to improve communication quality
BAME Scientist Trainee Network gave a really important session on ‘Diversity in access to education’
The session was really impactful for me and I believe having these kinds of sessions and conversations is key if we are going to address some of the issues raised.
For those coming into the healthcare system as staff members, white applicants for posts across the NHS are 1.5x more likely to be appointed from shortlisting than non white applicants. In order to change the system that permits this we need to start with education and therefore understand the biases of the system that recruits into it. This challenge was shown to also be reflected in the STP appointment scheme, where the average success rate was ~5% but for Black/Black British – African applicants the success rate was ~1%.
When in post 1/3 of BAME staff report having been harassed or bullied at work either by patients or their colleagues.
For those coming into the NHS and healthcare systems as patients healthcare inequalities exist and are often based on myths that emerged from 18th century studies linked to slavery, such as black people feel less pain as they have less nerve endings. Within the NHS black women are 5x more likely to die in child birth and black patients at half as likely to receive pain medication.
Not only are the issues backed up by research and other evidence but there is also data to show that promoting equality, diversity and inclusion does not just benefit BAME groups, and therefore benefits the workforce and patient population as a whole.
So what can we do to support our BAME colleagues?
The following suggestions were taken as part of a qualitative research study from BAME and white Healthcare Scientists, rooted in their lived experiences (as we learnt from Rowen, this permits the exploring of why and how questions).
Advice for leaders:
Unconscious bias training – manager and leaders have the biggest influence and it was felt could have the biggest impact on as inclusive environment, and that active allyship was key
Diverse influence panels – decreases the collective effects of unconscious bias
Monitoring for training opportunities – ensuring equality , measure and monitor metrics and review access
Mentorship, including reverse mentorship
Diverse teams
Zero tolerance of inappropriate language, awareness of micro aggressions
Equal opportunities for showcasing skills – ensuring that extra curricular activities or additional responsibilities were accessible to everyone, not based on connection to a manager
Practical advice to address specific needs i.e prayer room location, halal food options, joining staff inclusion networks
Review clinical practices and ask whether they are contributing to health inequalities
No matter what your role you have the ability to take steps to counter the data shown and so this is a call to action and take steps as individuals, teams and organisations to address these issues.
Dr Jane Freeman and Dr Kerrie Davies, NIHR clinical lecturers and clinical scientists, ‘Communicating differently’
To finish off the morning with a bang Jane and Kerrie called on us to really think who are we, and not just our scientific credentials……. what is our talent, not just our ability to plate 200 samples and hour…….and to think who are the audience we’re trying to reach? What is the message your trying to get across? How can you make it memorable? One size does not fit all??
Communication is about connecting with people and that involves taking risks, doing the unconventional, bringing whole self to work………..not just Dr XXXX but all of you. As I have said in a previous blog I do my best science over a cup of tea and Jane and Kerrie emphasized that talking is key, with conversations being the starting point to any success piece of work.
Actions however speak louder than words and so below is my (rather shoddy) recording of one way that Jane and Kerry show that actions speak louder than words. Enjoy the Small Faeces discussing ‘Quality’!
For the afternoon session we moved onto the workshops. There were three streams to choose from:
Stream One – Innovation in outreach by Victoria Heath and James Harkin, followed by Royal Literary Fund – Rooftop writers by Nicola Baldwin
Stream Two – Top tips for delivering educational activities online by Justin Poisson, followed by Evaluation of digital education by Ian Davies and Matt Coombes-Boxall
A starting reflection on the transition to digital delivery from face to face learning. A move from reactive remote learning to blended learning. Sessions were put together to lecturers and students. ‘Moving your lectures online’. Online induction resources’, ‘Talking into the void’.
The session then talked about learning technologists, and translating practice to the educational environment. Opportunities were given for staff to showcase how they moved their online to a digital format.
Retention research has highlighted that regular feedback was important and that to support this the community of inquiry model was encouraged as something to think about when delivering sessions.
There was also a demo different learning software’s that could to help with engagement: Flip grid, Wakelett, Mural
Stream Three – Maintaining your education during a pandemic by the London Healthcare Scientist Trainee Network, followed by Influencing upwards by Cherie Beckett
I was lucky enough to be supporting the stream three session which was kicked off by the LHCSTN who ran a really interactive session getting everyone in the room to explore and score (1 – 10) whether the pandemic had impacted on 7 key areas, either as a trainee or a trainer:
Redeployment/role changes
Exposure to practical clinical skills
Rotations and placements
Research projects
Staying connected
Virtual learning
Wellbeing
We then talked through the learning and different ways those in the room has dealt with the high scoring impacts they had experienced.
Cherie then followed on with an equally interactive session exploring everything from how we introduce ourselves i.e. ‘just a trainee’ or using banding, to how to expand your influence. The group spent time identifying barriers to influencing up and reflecting on whether some of those were self imposed. Then we moved onto to talking about how to navigate around those barriers or coping strategies for the internal ones.
The final session of the day was the plenary given by Vivienne Parry, Science writer and broadcaster (and all around Healthcare Scientist champion)
Viv finished the day in inspiring style by reminding us all of why what we do matters, the impact that we have but also re-iterated the message of the day – that we have to be seen! We need to talk to people like we do to our families and explain what we do and why it’s important. Not speak like we do to our colleagues, not like we are speaking to a Guardian science reporter, but like we do when we are outside work. That is how we talk in a way that is heard and received. We are too important to be invisible and now is our time to shine!
NB – these are the meaning of the sessions as I received them as a member of the audience, hearing through my own lens, these are not verbatim notes, although I’ve tried to be as accurate as I can. All opinions on this blog are therefore my own
This week’s post is about some of the challenges of having healthcare conversations when not in a work context. With increasing frequency I get asked to give medical advice and guidance in social settings, often indirectly: i.e. being asked not by the affected individual. When I’m talking about conversations today I’m not talking about the ‘I’ve been prescribed X antibiotic what does it do?’ queries. These kind of queries are about giving information and signposting, rather than diagnosis or critical review. The conversations I’m talking about here are the, ‘my aunt has just been diagnosed with pancreatic cancer, can I send you her biopsy picture?’ type of dialogue. I’m writing this because sometimes, when I back out of these more significant conversations, I worry that it can come across as showing a lack of interest or as being callous and uncaring. The opposite is true, but there are constraints as to how much I can become involved. And some very good reasons why it might be inappropriate… I thought it might be good to share.
First things first. I’m not a medical doctor, I’m a Healthcare Scientist with a PhD and the same post-graduate qualifications as my medical microbiology colleagues. This means that I am qualified to give advice within specific confines linked to infection and infection control. I do not, however, have their broad breadth of experience or – therefore – associated expertise outside of this area. I think it’s really important to be aware of professional boundaries. That said, compared to many members of the public and due to working in infection control (which sits across subject areas), I have an awareness of healthcare linked to a number of disciplines. I thought it was important to write this here because I think if you work in healthcare this delineation is taken for granted. We often forget it’s not as clear to those who don’t.
Are You Talking to Dream or Dr Cloutman-Green?
Many of you who read this blog regularly will know I go by four main names. My friends have called me Dream since I was a teenager, as I was always day-dreaming and walking into things. I get called Elaine by work colleagues and, when I’m in trouble, by my family. My brother and sister have always called me Laney when they are not mad at me. Then there is Dr Cloutman-Green, who you’ll meet in a professional context.
Now I’m no Beyonce/Sasha Fierce, but I do think that there is some context-specific nature to the way I engage with the outside world. I try to be authentically me no matter what context you engage me in, but Dream isn’t the same as Dr Cloutman-Green. Dream drinks shots, enjoys trashy TV and has been known to dance on the odd table. Dr Cloutman-Green deals with making significant and serious decisions all day, everyday, and so has to deal with a fair amount of pressure and stress. As Dream, I do my best to leave that at the door when I come home. It is always quite jarring when Dream gets asked questions and is involved in conversations that are in Dr Cloutman-Green territory.
How Much do You Really Want to Know?
The main issue with Dream having conversations that would normally be had by Dr Cloutman-Green is that Dr Cloutman-Green has access to all kinds of information and resources that Dream doesn’t. Examples of these are when you get called up by a friend or relative asking if they can send you photos/tell you about a friends medical condition. One of the cornerstones of professional practice is understanding when you don’t have all the information and when you are stepping outside the scope of your experience. If I have those encounters in my day job, I have access to medical records, expert colleagues, test results and the ability to recommend follow up investigations. As Dream I have access to none of those things, as well as second hand information given by someone else without knowledge of individual consent.
The other reason that these conversations can be challenging is that you may be aware of the potential serious outcomes of the information you are being given for the individual without the information to determine likelihood. For instance, I am aware of poor outcomes associated with certain cancers. If the person involved has not been prepared for that conversation by their medical professional, or if the conversation has happened and they have not been able to process. Is it appropriate for me to wade in, unaware of the complete story, in what is the professional remit of another healthcare professional?
Finally, if the news is not good there is a reason that these conversations are undertaken by a healthcare professional with some distance from the situation, rather than your friend/relative. Emotions can be targeted, whether justified or not, at the person delivering the news. There is a reason we talk about ‘don’t shoot the messenger’ and ‘being the bearer of bad tidings’. Being involved in these conversations, whilst not being so involved as to have all the information, can result in permanently changed relationships on both sides. It strikes me that in these circumstances I should mostly be there to signpost and support as a friend, not acting as their medical professional.
Having laid out my rationale you would have thought it would be fairly simple to keep these worlds siloed, but it isn’t. These conversations are often sudden or sprung in unusual situations where you’re not expecting them and, therefore, take time to adapt and respond to. Hence the fear of coming across as distant.
But I Thought I Was Just Here to Party?
Stepping away from the more serious conversations, there is just one more setting where I find this topic difficult:
The Art OfParties.
Now I work in a paediatric setting and so, understandably, many people want to talk to me about paediatric infections. That sits well within my ball park of expertise. There have been occasions, however, that despite this, and the situation not requiring serious conversations, I’ve not wanted to engage. I was once invited to a party (it was supposed to be child free) and when I arrived, apart from my husband and I, everyone there was a family unit with kids in tow. That’s fine – I’m OK with that. As the afternoon/evening progressed, however, I became progressively less happy. I was basically on a conversation carousel of parents who wanted to talk about herbal remedies for their kids cold, whether the fact that their child had had three colds that year warranted paediatric referral, or whether vaccination X should wait because of their trip to Y. After 6 hours I had managed not a single Dream conversation. Nothing on a non-healthcare subject. Not one conversation about movies, books, geekery or the things I enjoy talking about outside of work. Not only that, but because I kept being pulled into these conversations, I felt less and less like I was at a party and more and more like I was work.
When all is said and done, I expect to talk and love talking about science, medicine and my day job. After all, I have the best job in the world. There are just also times when I need to talk about things that aren’t linked to these. I struggle with small talk and therefore really don’t help myself as sometimes (well quite often) my work is all-encompassing. It is therefore frequently my own fault and actually just a way that people use to try and connect with me. It’s something I need to work on. If we do meet in a social setting though, please talk to me about tea, cake, your favourite novel/film/TV show and help me be Dream/Elaine rather than Dr Cloutman-Green. I’m keen to know more about you.
Also, if we meet and you do want a serious health-based conversation, understand that, if I don’t fully engage, it’s not because I don’t care about you. It’s because I care about you enough that I want you to have medical advice from the person who has access to all the information and resources to take the best care of you, your healthcare professional. Also know its because I value you and our relationship enough that I don’t want to risk it being damaged by changing the context of that relationship to something that should be more distant and professionally limited. I’m still here for you, and I still want to support and signpost, but let me be your friend rather than your Dr.
Whilst Girlymicro is away trying to find some of this work life balance people keep talking about, the charming and wonderful Claire has stepped into the breach to keep you informed and amused. Isn’t she lovely!?
Blog By Dr Claire Walker
Paid-up member of the Dream Team since 2013 (as discussed in a previous post, in her personal life most people call Girlymicro Dream), token immunologist and occasional defector from the Immunology Mafia. Registered Clinical Scientist in Immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln.
Did you hear the one about the Consultant Microbiologist who Hosted a Digital Festival
of Science collaborating with Artists, Musicians and even Comedians?
She was a Woman of Many Cultures
That’s right! I am, of course, talking about The Rise of the Resistance festival, the greatest scientific communications event since Jonathon Van Tam’s daily Covid briefing. Someone please buy that man a clicker (JVT, if you’re reading this, hit me up I have a spare for you).
More seriously, if the constant stream of scientific content in the media over the last 15 months has taught me anything it is that scientists are not always the best communicators. We have to ask ourselves why this essential skill is being overlooked by our profession. Is it because our subject matter is so complex? Or is it because we’ve never taken the time to learn, practice and apply these skills?
I’ve spent more than a decade developing a detailed understanding of how clinical testing works but only shared my findings with other healthcare professionals, and rarely outside my own discipline. The importance of clinical testing is now taking centre stage and, because of the pandemic, I am finding myself butting heads with every armchair expert who believes they know more about my specialty than me. I’ve been frustrated by this, but now I think it’s my own fault. I’ve spent too much time hiding in the lab and not enough time shouting from the rooftops about just how vital, influential and downright amazing our healthcare scientists are. It’s time for me to put down the pipette and pick up a microphone.
Pathologists as Comedians – are we Having A Laugh?
I decided to jump on the first opportunity to come my way. And that was the offer to participate in Stand-up for Science, a live comedy gig as the closing act of the Rise of the Resistance festival. My first thought was that stand-up comedy is about a million miles from my comfort zone. However, I was fortunate to receive the excellent training of professional scientific comedian Dr Steve X Cross. With this new knowledge and the support of my fellow scientific comedians, Dr Cloutman-Green and Kip Heath, I wrote my set.
The training taught me that worlds of science and comedy are not so far removed as you might think. My job as both a scientist and an educator is to find the best method of communicating complex ideas to a varied audience, and I spend much of my time giving presentations to large, mostly awake, crowds.
Fortunately, the gig itself was all delivered from the comfort of my home office. For those of you who didn’t manage to watch live (including my lovely husband who was juggling the children) I’ve attached the link here. I felt that the gig itself was brilliant, a wonderful experience to meet funny and passionate individuals from across the pathology disciplines. We covered everything; from classic urologist finger up the bum humour, to carefully constructed gags about our doctorates, to fishing samples out of a bin at the Brit Awards.
There are a lot of great stories for healthcare scientists to tell, and rarely have I had a day in the clinical lab without finding something to laugh about. Much like learning how to design an experiment, or program the flow cytometer, communication is an essential skill for healthcare scientists. And why should it be dry and boring? Why not throw in a joke or two? We aren’t going to win friends or influence people by mansplaining our work or dismissing it as too complex for the lay person to understand.
Now, more than ever, we have a responsibility as scientists to get out of the lab and make ourselves heard. Getting the right test for the right person at the right time, the mantra of the clinical scientist, is essential. Spreading understanding of clinical testing and of vaccination will save lives. Today.
TLDR: Scientists, even microbiologists, are people too. And some of us are downright hilarious.
Well the first set of events for Rise of the Resistance brought has just finished. There are already plans for part two of the Festival to run on the 3rd and 4th July, but before that happens come look at what took place over the last 72 hours!
Some adult content to do with comedy, music and drag! (warning: there is swearing in these.)
KLEBSIELLA by Peter Clements: “A portrait of Klebsiella through a psychoanalytic session”.
Never Explain
A Comedy panel show about Antimicrobial Resistance hosted by Steve Cross
Stand-Up for Healthcare Science
Comedy and Cabaret from the ‘best minds in science’…. A partnership with the popular Science Showoff comedy night hosted by Steve Cross.
Now onto the panels! Where science and creativity meet
Panel 1 SPIRALLING – How To Begin the AMR Conversation
Panel 2. INTO THE BREACH – Bugs and Behaviour
Panel 3 NOSOCOMIAL – The Value of Collaboration
Panel 4. ME AND HER – Human and Animal Impact of AMR
Finally, here are the dramatic and creative pieces for kids and families, with no adult content
Nosocomial by Nicola Baldwin
A digital version of the play that started it all. Verbatim drama premiere. There is nothing weird or wonderful you can imagine in human experience I haven’t seen. I’m a Researcher in Humans.
Sock the Puppet by Nicola Baldwin
A story for children about Socks, Science, Superbugs and Making Friends, narrated by Stephanie Houtman
Remember, Remember by Nicola Baldwin
Join our time-travelling Zoom Healthcare Science in a detective drama about the *True* story of the Gunpowder Plot.
INHALE Poem by the INHALE Research Group
What’s Next?
This project started at a collaboration between myself and playwright Nicola Baldwin and has grown so much since then to include so many people, both scientists and artists.
For those of you who are interested in learning more about how this project came about, check out the blog post I wrote about it last year here.
Find out more about the NIHR Precision AMR grant that funded this work here and the pilot projects that have been funded by it here.
More events will be launched prior to our new event showcase on the 3rd and 4th July
Keep an eye out on the website for updates and booking details.
If you’ve watched any of the content please take the time (it will only take a few minutes) to complete the evaluation form below and return it to the email address on the form. It will help us do things even better in future!
Finally. A massive thank you to everyone who has given their time to contribute, watch, and make this happen: Thank you also to the wonderful bodies that have supported us: we couldn’t have done it without you.
As the Rise of the Resistance Festival is happening this week, I’ve been talking to quite a lot of people about antimicrobial resistance. What has struck me is that something that has such a massive day-to-day impact on my working life hasn’t really made its way into the public consciousness just yet.
I thought I should take the opportunity to repost a blog I wrote in 2020 to talk about antimicrobial resistance, and why I think we should be working hard to talk about it more: in the pub with our friends, with our families over the summer, and with our patients and students.
Photo courtesy of Anthony De Souza
What Is Antimicrobial Resistance?
When I go into classrooms and speak to members of the public they sometimes think that antimicrobial resistance is when our bodies become ‘immune’ to antibiotics. This isn’t the case. When we talk about antimicrobial resistance or, for the rest of this blog post, antibiotic resistance (as I’m talking about bacteria) is when the individual bacteria are not affected by the antibiotic or it works less well (see my introduction to antibiotics post for a bit of background).
Antibiotics work in two main ways. They are either:
Bacteriostatic = inhibits the growth of bacteria.
Bactericidal = kills bacteria.
The way the antibiotic works against the bacteria can be linked to the way that the bacteria become resistant to the antibiotic. I’m going to do another blog post with some of the technical details of how this works and how we detect it, so bear with me for a couple of weeks. For this post, the main thing is to know that it is the bacteria that become resistant, not us, and that there are a number of different ways that this can happen:
Intrinsic resistance = the antibiotic will never work against that particular bacterial species because of the characteristics that species has. This includes things like Vancomycin not working against Gram negative bacteria as the molecule is so large.
Selective resistance = where a mixed population of resistant and sensitive bacteria are impacted by antibiotic use and the resistant ones survive and therefore become dominant.
Acquired resistance = where previously sensitive bacteria acquire the ability to resist the effect of an antibiotic, often through acquiring genes, which allow them to change the way they function or replicate.
Levels of antibiotic resistant bacteria are being detected in increasing numbers in food (linked to farming), in the environment, and within humans: both in hospitals and in the community. It’s for these reasons (and others) that it has been modelled that more people will die linked to antimicrobial resistance than cancer by 2050. If, as a population, we have more resistant bacteria onboard as part of our normal flora, it is increasingly more difficult to treat us when we need it. It will also become increasingly more difficult to do ‘standard’ surgeries such as hip replacements, tonsillectomies etc. as these require us to give prophylactic antibiotics when in surgery in order to reduce infection risk. This means we may have to live with long-term conditions that currently we would surgically correct.
Most of us think about antibiotics as being something that we either give to really sick people in hospitals or a fairly harmless way to get back to our every day lives when we’re feeling unwell at home. In many ways that is true. Most of us will have had multiple courses of antibiotics during our life and have never given it much thought. Some women may have had the odd bout of thrush when they’ve taken antibiotics for a urinary tract infection and that is the closest they’ve seen to side effects. The case of a woman getting a fungal infection (thrush) because they’ve taken antibiotics that have wiped out the non-harmful colonising bacteria in their vagina is a pretty good example of exactly what can happen in less obvious sites when we take antibiotics. For example, there’s plenty of data that the use of antibiotics can impact on the bacteria in your gut, providing selective pressure and changing what the population of bacteria looks like. Usually this returns to normal over time. However, in a world where the bacteria we encounter are increasingly resistant, that return to normal could take longer; if they got out of the gut to another location due to surgery during that time they could be more difficult to treat.
Colonisation vs Infection
Most of the time, if we have resistant bacteria onboard we would never know. They are colonising us, just like our normal bacteria, and not causing us any harm. There’s good data to show now that when we travel abroad to countries with a high prevalence of antibiotic resistant bacteria in food or the environment, that we may exchange some of our sensitive bacteria for resistant ones. You’d never know, especially as when we get home they will usually be replaced again with sensitive versions. However, if you happen to get an infection whilst you have them onboard because you’ve had an accident on holiday, or you’ve travelled for medical care overseas, then the infection may be more difficult to treat.
It’s not just the antibiotics we use in humans that can make this situation worse. Antibiotics are used as growth promoters in farming. We use antibiotics to treat our pets. Because of how expensive and difficult antibiotics are to develop, we are not really developing new ones and so the pool of available antibiotics is getting smaller.
Because antibiotics are used in so many different ways in solving the issue of how to impact levels of antibiotics, resistance is complicated. It requires us to be able to diagnose and detect resistance faster, to work with drug companies in order to tackle the drug development pipeline, and to take a ‘One Health’ approach, looking at farming and veterinary approaches as well human.
So, what can I do?
Be aware that not all mild respiratory and other conditions require antibiotics. Many are viral and will improve with rest and hydration. Therefore, consider waiting before requesting a prescription for antibiotics.
If given a prescription, make sure you complete the course. Do not just stop because you start to feel better. Stopping early might mean that you have not completely treated the infection and the remaining bacteria can grow back and sometimes develop resistance.
Do not buy antibiotics when you are abroad in a country that permits an over-the-counter purchase.
Do not store antibiotics and use them at a later date. Neither should you use antibiotics that were prescribed for a family member or (and I know of people who have done this) a pet.
Think carefully about whether travelling abroad for healthcare is the right choice; make a risk assessment about where you are planning to travel.
If we want to continue to experience healthcare in it’s pre-COVID-19 form, we all need to work together to change the way we use antibiotics so that the modelling predictions do not come true
It all started with a conversation Help us keep that conversation going and enjoy some great events along the way!
Rise Of The Resistance is a digital festival of creative responses to Antimicrobial Resistance (AMR), on 3 – 5 June 2021.. Curated by NOSOCOMIAL, an award-winning collaboration of Healthcare Scientists and theatre makers which hosts performances, panels and events.
We have events designed for:
Children and families.
Those interested mainly in the science.
Those mainly interested in the creative pieces.
A grown up audience (due to language content i.e. swearing).
Healthcare Scientists are 5% of the NHS workforce in the UK, responsible for 80% of diagnoses. Rise Of The Resistance celebrates the impact of Healthcare Science. It seeks to reinforce relationships between Healthcare Scientists, patients, families and the public, believing that better communication and understanding are vital for managing future threats to global health such as AMR.
NOSOCOMIAL comprises around 25 scientists and artists. We won the 2019 CSO Partnering Patients and Citizens Award, and 2020 Antibiotic Guardian award for Public Engagement. Rise Of The Resistance is our first festival.
Events For Children and Families
SOCK THE PUPPET – aimed at families and children aged 7 and under
Fri, 4 June 2021 – 10:30 – 11:30
A story for children about Socks, Science, Superbugs and Making Friends, narrated by Stephanie Houtman
Meet Sock the Puppet. Sock is excited to go and sing for the children in Hospital with Ms Clown. Sock loves the Hospital. It is always clean and tidy.
The children love Sock’s singing. All the children hug Sock.
When Sock catches all the bugs that make the children poorly, Sock has an adventure to the cleanest, tidiest place in the whole Hospital: The Laboratory.
Can you help Sock find a way back to Ms Clown and the children?
Join us at Rise Of The Resistance for the story of Sock, narrated by Stephanie Houtman (Peppa Pig Live), directed by Saskia Marland, with a special appearance by Sock.
After you book tickets, you will receive a worksheet to make your own Sock at home, designed by artist and maker Abi Bown.
Created by the team behind Nosocomial and Remember, Remember! – playwright Nicola Baldwin, and Healthcare Scientists Vicki Heath and Dr Elaine Cloutman-Green BEM, of Great Ormond Street Hospital.
Sock The Puppet will also be available as a podcast.
With thanks to Eibhlin Jones, Laura Walsh, Amy Sutton and Tara Kearney.
REMEMBER, REMEMBER – aimed at families and children up to GCSE age
Sat, 5 June 2021 – 11:00 – 12:00
Join our time-travelling zoom Healthcare Science in a detective drama about the “True” story of the Gunpowder Plot. For ages 5+ to 105+
A Zoom storytelling science drama.
REMEMBER, REMEMBER! is a pre-recorded Zoom drama. You will receive a link to watch the online premiere.
Activity books, and script, will also be sent out so people can take part at home.
London, 2021. Healthcare Scientists Lily, Rosa, and Frank receive a mysterious message for ‘HELPE’ on one of the machines in their hospital laboratory.
London, 1605. Plague stalks the land, leading to unrest… and a plot to blow up the King and Parliament. Guy Fawkes is arrested and the race begins to track the rest of Gunpowder Plotters.
Remember, Remember tells the amazing story of how three Healthcare scientists set out to foil the Gunpowder Plot, with the help of nine year old Princess Elizabeth, a malfunctioning MALDI-TOF machine and the weird and wonderful mysteries of Microbiology, Haematology, Biochemistry, Immunology, hand-washing, and… time travel.
And they need your help.
with
LILY / SIR JASPER – Jennifer Daley
ROSA / TOWER GUARD – Becky Simon
FRANK / GUY FAWKES – Jonny Wright
PRINCESS ELIZABETH – Tara Kearney
Produced by NOSOCOMIAL
By playwright Nicola Baldwin and Dr Elaine Cloutman-Green, Lead Healthcare Scientist at GOSH. Activity Packs created with Anthony Manuel DeSouza, with input from Fionnuala Wilkins at GOSH school, and Amy Sutton of GOSH Youth Forum.
Thanks to Hannah Jones, Peter Hamilton Dyer, Abi Bown.
Originally produced for Pathology Week 2019, supported by HSEWG and The Royal College of Pathologists (RCPath) as an online drama for children and families in hospital isolation due to illness, revived in 2020, and made available thanks to the Society for Applied Microbiology, as the whole country went into isolation..
We hope it will provide an informative and entertaining way to learn about viruses and bacteria, and that you enjoy watching it at home.
IF I DON’T PLAY I WON’T UNDERSTAND. Plus PPI panel -an interactive drama experience for the whole family
Sat, 5 June 2021 – 14:00 – 15:00
Welcome to the “Bacterial Leisure Centre”! We are the best fitness centre for bacteria in the microbiome to train for bacterial success!
Our Leisure Centre is located in the heart of the breathtaking Microbiome Resort, set in a 2,700 square feet of the Gut. The Centre is provided with anatomy room, gym, quorum sensing zone, reproduction area, and many other 1st class facilities.
Our team of experienced trainers will coach and guide you in this adventure of becoming bacteria, and they will make sure you will have an unforgettable experience.
What do you need to do?
Sign up to a free virtual taster session on Saturday the 5th of June @2pm.
Be prepared to renounce your humanity for the duration of the taster session.
As part of our fitness activity, we will ask you to play games and move your body.
No previous fitness experience is required, but be ready for a lot of fun and games activity.
“If I don’t play I won’t understand” is an interactive digital game performance, combining transmedia storytelling and fictional reality with games and movement activities.
Inspired by choose-your-own-adventure books, audiences are invited to sign up to a virtual “Bacterial Leisure Centre” where they renounce their humanity to train to become bacterias.
After a welcoming virtual tour of the Centre, the audience can choose their own adventure by deciding which training room they want to enter. Once in the room, the audience will meet a specialized trainer that will train them to become bacterias by using games and participatory activities.
“If I don’t play I won’t understand” is designed and directed by Monika Gravagno, the AD of Facciocose Physical Theatre company.
This will be a participatory physical theatre/workshop to explore communication and expression from a microbial perspective.
Followed by a panel discussion: How To Engage An Audience With ‘Difficult’ Science
After the workshop, stay for a panel discussion and Q&A with the makers and invited guests, to explore the outer limits of public engagement; the mutual benefits of PPI to artists and scientists in framing research questions, and creating new forms of work.
For Those Interested in Talking Science Supported by Drama
SPIRALLING & How Do We Begin The Conversation?
Fri, 4 June 2021, 14:00 – 15:00
In a time when views are drastically polarised, could questions potentially bring us together and not drive us further apart?
Screening of SPIRALLING by Jimena Larraguivel, followed by a panel discussion with Dr James Hatcher, Dr Melisa Canales, Professor Brendan Gilmore, Sue Lee: on PPI, clinical trials, and how do we begin the conversation on AMR?
“The idea behind this short film emerged in response to the overwhelming amount of information available on social media, which has undoubtedly had an impact in the way I navigate motherhood and take decisions in the best interest of my children. In a time where cancel culture seems to be the norm, it’s daunting asking questions. However, in a time where views are drastically polarised, aren’t questions what could potentially bring us together and not further apart?”
The doctors want to be sure that I’m not using. Fair play, I get it, course, I do. But I’ve been with heroin since I was 17. It’s up here.
Screening of INTO THE BREACH by David Milner, followed by a panel discussion with Dr Jane Freeman, Angela Mwape, Ruth Thomsen and Francis Yongblah on bugs, behaviour, their impact on on AMR, and what we really mean by ‘hard to reach patients’.
“Hostel dweller COLIN reflects on his past life and uncertain future while negotiating the reality of London’s streets. Colin’s in limbo, awaiting an operation; his body must be drug-free for surgery, but addiction has been the one constant in his life.”
How do we cope with the total disruption of infection? What’s the prognosis for the things we take for granted in our lives?
Screening of ME AND HER by Rebecca Simon, followed by a panel discussion with Professor Mark Fielder, Dr Elaine Cloutman-Green and Professor Nicola Williams, on the impact on, and of, human and animal behaviour in AMR, and the need to focus on One Health.
Home is where the heart is, where we feel most like ourselves. After almost seven months living in a ten by twelve foot hospital room with her sick daughter, Zoe escapes to home. To feel like herself again and that she still exists outside of that hospital room, outside of being a mum. But home doesn’t feel like home anymore, there’s been a shift, things are not as she would have them. She feels displaced and lost.
ME AND HER is a short film exploring the experiences of parents, carers and their families whose lives are profoundly altered by long term hospital stays. When suffering through a difficult and challenging time in their life, how do parents who are carers cope with the total disruption of their lives? What’s the prognosis for their careers, relationships and sense of identity?
The Piece That Started It All – NOSOCOMIAL & Collaboration within Public Engagement
Fri, 4 June 2021 – 20:00 – 21:00
Verbatim drama premiere. There is nothing weird or wonderful you can imagine in human experience I haven’t seen. I’m a Researcher in Humans
When I say I’m a healthcare scientist, they ask “do you work with animals?”When I tell them I work in a hospital, they say “are you a nurse?”There is nothing weird or wonderful you can imagine in human experience I haven’t seen. I’m a Researcher in Humans.
Screening of NOSOCOMIAL followed by panel discussion on Collaboration within Public Engagement with Dr Lena Ciric, Saskia Marland and Monika Gravagno.
Jo is not well. Something strange is happening. As a scientist, she can resolve this. Unless the world is infected. Unless it’s everywhere….
Kitty, Helena and Paul work through the night. An hour can make all the difference. Part thriller, part puzzle, the science of life and death.
Join us for the online premiere of our short film.
JO – Jimena Larraguivel
HELENA – Becky Simon
KITTY – Nicola Sanderson
PAUL – Peter Clements
Healthcare Scientists are 5% of the NHS workforce, responsible for 80% of diagnoses.
Forensic pathologists are a staple of TV crime drama and Healthcare Science has dominated news headlines during months of pandemic, yet the role of Healthcare Scientists themselves remains largely unknown. You don’t see us on Holby. Science is too ‘difficult’ without explanation. Yet working in basement labs,working with patients, working with families over years, the HCS experience is varied, vital, and their personal stories are remarkable.
Nosocomial began as a collaboration between playwright Nicola Baldwin and Dr Elaine Cloutman-Green, Lead Healthcare Scientist at Great Ormond Street Hospital. In summer 2018, over 30 Healthcare Scientists from various hospitals took time out of their schedules to join writing workshops, which later grew to involve artists and actors, to tell their stories.
Performed at Camden Peoples’ Theatre and site-specific events in NHS buildings, museums, and other public spaces. Winner of 2019 CSO Partnering Patients and Citizens award, and 2020 Antibiotic Guardian award for Public Engagement, this is the online premiere of our new short film, updated for 2021.
The Nosocomial project has been made possible thanks to SfAM and HIS public engagement grants.
Inspired by classic 1963 thriller by Val Guest (from book by Elleston Trevor) about scientists battling a smallpox outbreak
A Healthcare Scientist’s already-shaky marriage is tested to an even greater extent when he has to contend with a smallpox epidemic.
Inspired by the classic 1963 British black and white medical thriller adapted and directed by Val Guest (from the book Pillars Of Midnight by Elleston Trevor) about Healthcare Scientists battling a smallpox outbreak
For one night only, this live zoom script reading will pay homage to the iconic black and white movie experience.
Please dress appropriately, and return with us to a bygone era of Saturday night cinema-going, reimagined for the digital age, via the medium of Zoom in your own sitting room.
A unique experiment in co-creation involving a virtual company of actors, artists, scientists, researchers, and you, the audience.
It’s New Year’s eve. You get a call to go into the lab.
Microbial shapeshifter. Compulsive stealer of DNA. Who is she? Why does she do it? In a crisis of identity Klebsiella seeks psychotherapy…
Screening of KLEBSIELLA by Peter Clements, a new performance in development, followed by a panel discussion with costume designer Pam Tait and Healthcare Scientist Dr Elaine Cloutman-Green: on performance, playfulness and the need for novel approaches to engaging with AMR.
“A portrait of Klebsiella through a psychoanalytic session.
Klebsiella is the shapeshifter of the microbial world. A compulsive stealer of DNA. Who is she? Why does she do these things? In a crisis of identity , Klebsiella seeks psychotherapy to get to the bottom of what’s bugging her.
Klebsiella and Analyst meet to determine if Klebsiella is suitable for in depth psychoanalysis. Klebsiella resolves that she’s impossible to cure. She’s determined to find the love of her life, even if it means leaving a trail of destruction behind her.”
Comedy and Cabaret from the ‘best minds in science’…. A partnership with the popular Science Showoff comedy night hosted by Steve Cross.
Healthcare Scientists become comedians for one night only.
Tonight they’ll put aside their microscopes, computers, samples and equipment for one night to tell you jokes about their work.
The show will be hosted by comedy veteran Steve Cross, who has MCed hundreds of comedy shows of all kinds across the world, and who has trained these brave brainiacs to take to the stage. I say stage, they’ll be on a videolink from their own homes.
The gig will be made available to to ticket holders via a live stream from all of the performers’ houses. Ticket holders will be emailed details of the stream on the day of the show.
The show is on 5th of June and starts at 6pm prompt.
It’s just gone 6am on a Saturday morning and I need to get some writing done this weekend for a project that is overdue and has a final final deadline on Monday. It’s been a really long week and I don’t have much in the tank. To be honest, all I want to do is sit on the sofa with a pot of tea and spend the weekend watching Netflix with my hubby. I think we all have moments like this, and, to get me into the right head space, I’m starting my morning by writing this blog. I hope this might help some of you who are in the same place.
Know When Procrastination is Part of the Process and When You Are Just Wasting Time
When I was writing papers and my PhD thesis, I used to get really angry at myself for wasting time.I would spend the first three days wandering around and doing anything but putting words to paper. When I did sit down, I would just get words out. In general it takes me about two days to write a paper. I would then be even madder at myself for not getting to it earlier as I felt that I could achieve so much more if I just focussed.
Over the years I’ve discovered that the reason the words come easily when I sit down at a laptop is precisely because I’ve spent three days prevaricating. During that period of wandering around I’m thinking. Thinking about the story I want to tell with my results. Thinking about my top points. Finally, thinking about structure. It is all of this thinking, not all of it active, that enables me to hit the ground running when I come to actually write.
This isn’t to say that I’m not guilty of procrastination. There’s a reason this book chapter is late. I’m tired and finding it difficult to concentrate, which means that everything just makes my mind wander. It is really important to know yourself enough to know when you are in ‘preparation phase’ vs ‘procrastination’: one is useful to you and the other isn’t.
The Fear of a Blank Page
I find blank pages intimidating. I do. I know that I should see them as full of possibility and exciting, but I see them as a physical representation of how far I have to go. One of the first things I have to do, therefore, is get stuff onto that page in the least stressful way possible. How to do this depends on what the project is. For papers, I often just start by getting headers down. If I’m lucky enough to have some previous text on the subject I will copy and paste bits in as reminders. Usually I keep these highlighted so I know they are old text that needs re-working/replacing. If it’s something completely new, I will populate with lines from papers that I’m going to build reference structure around.
When I was writing my thesis, I wouldn’t even start chapter writing until I’d done a reading phase to help avoid the ‘blank page fear’. I would spend a week reading all the papers linked to the chapter I was about to write. During that reading phase, I would write the key points and linked references down in a Word document. I’d then shuffle them by topic. When I got to the week allocated for writing I would then have lots of text to import into my structure so I could avoid the blank page terror.
Structure is King
I’ve spent quite a lot of time writing different types of documents and I’ve discovered that there are only so many types of underlying structure, even though they often look different. Papers are a great example of this. One main advantage to them is that you can clearly see what that structure is, and you have access to all the information you need to help you.
When writing papers (and I’ve blogged about this before) you can look and see how many paragraphs that journal tends to have under discussion vs methods vs results. This helps you know where you need to focus the majority of your words. The same is true for grant applications: if you look at a section’s word count, it gives you a clue about what the readers will want to see. For less formal writing, I still tend to look at other pieces of content that have come out and decide if any of them fit what I want to write. It saves re-drafting and focusses the mind.
Structure will help you write. I will use bullet points under headers to show what my structure is, i.e. a bullet point per paragraph. If there are three paragraphs (such as tends to be used for an introduction) I will use them as follows:
Paragraph 1 – What’s the setting/problem?
Paragraph 2 – What are the knowns and what are the unknowns?
Paragraph 3 – What am I going to do? what’s the plan of action?
By planning my paragraph structure I try to avoid falling down too many rabbit holes and maintain the story of what I’m telling. I am then able to do the same with each of the paragraphs:
Line 1 – State what I’m going to tell you.
Line 2 – Tell you what I’m telling you with all the detail.
Line 3 – Reinforce my key point and link to the paragraph that will follow.
Doing this means that I’m not worrying about what comes next when I’m writing. I’m just hanging words off a structure that helps me as well as leading the reader.
Sometimes The Only Way Is Through
There are times that, no matter how much research I’ve done, no matter how prepped I am, I just can’t make the writing work. I’m lucky. it doesn’t happen to me very often but the pandemic has made it a more frequent event. Normally I hate working in silence. I’m not good at doing one thing at a time. I need music or TV when I work to actually help me focus. I know this may sound odd to many people. When I hit a particular wall, however, I’ve learnt that I have to shift from the way working normally works for me. In these circumstances I call upon my husband, Jon. I tell him what I need, i.e. I must work for 3 hours to break the back of this document. I tell him the night before and let him know the timeline. The next day he banishes me to the office, frequently supplying me with tea. On these occasions I work in silence and need enough dedicated time to get into ‘the zone’. Because I don’t want to do it, anything that can make me distracted, will make me distracted. I therefore retreat to a space where all the things that usually help me aren’t present. This shift allows me to trick my brain enough to make progress. Finding your Jon to push you when you can’t push yourself is super helpful.
The other thing I do is make deals with myself and – most importantly – stick to them ,i.e. I am allowed to go and bake that cake I want to if I’ve done three hours. I am not allowed to do it if I do less than that. There’s no letting me off for good behaviour. This is a Yoda moment ‘Do or do not, there is no try!’. Being honest with yourself is key: after all, there is a good chance you’ll know when you’re lying. Make the reward proportional to the effort, i.e. when I run a half marathon successfully I buy myself a nice dress, for 3 hours work I get a new pot of tea.
Know When to Walk Away
Some days, be aware that writing is just not going to happen. This can happen for a bunch of reasons: tiredness, illness, last minute invitations to a cocktail bar. It is only possible to enjoy the freedom of walking away if it’s a) not a project that has to happen or b) you’ve left yourself enough deadline time so that you can come back to it later. If either a or b are true then sometimes it is better to just not punish yourself and return to it later. That’s completely OK. You may need more thinking time; you may be having a super bad day. Lets not punish ourselves more than we already do. Embrace the fact that you have project-managed well enough to let it go for a bit. Also, be aware that you only have so many free passes before you are sitting here early on a Saturday morning and there are no more to take. Use them wisely!
Top Tips:
Let the frustration with yourself go as it doesn’t get you anywhere. Work out the source and find a way through or around.
If you do the research on structures beforehand you may find the writing process easier and more efficient.
Know when you have time to defer and when you need to push through. Make an active choice rather than defaulting to the last minute.
(Apologies. This is a long one. Turned out I had quite a lot to say!)
This post has been languishing in my list of drafts for ages. After a difficult week, though, it felt like the right time to actually take it out of the ‘to do’ pile and finally finish it. The main driver for this is seeing how excited people are for June. The plans being made. The jubilance seen on social media. Weirdly combined with seeing yet more protests about the inhumanity of what has been done to society by lockdowns and mask-wearing requirement. All the time getting updates from India, Peru, Brazil about the realities of a virus that is out of control and still killing people globally.
I have previously posted about the dangers of looking at the situation and some of these responses from my position of privilege (Science Communication: Reflections from an Ivory Tower | girlymicro (girlymicrobiologist.com). I do, therefore, acknowledge that this is a complex topic and that people will write PhD thesis on the confluence of science, human behaviour and policy. I’m not that smart and so this post is just my personal tale of being an Infection Prevention and Control scientist surviving in the midst of a global pandemic, and why some healthcare workers may not be keen to re-engage with life as normal.
On the 31st January 2020 I posted on my personal Facebook about the fact that I thought the spread of SARS CoV2 was going to cause real issues along with some commentary and guidance. Some of what happened over the last 14 months I could have predicted. So much of the non-science and emotional/relationship impacts I could never have seen coming.
What Is This Work Life Balance You Speak Of?
I work in IPC because I enjoy the responsiveness of it. I love a challenge as I discussed in a previous post. The difference with this vs normal infection control is that it hasn’t been high adrenaline and intense for three days, or three weeks. This has been life for over a year. No matter how much you love your job, no matter how much you know the difference it makes, that brings with it a weight and a burden that no amount of resilience or wellness seminars are going to dissipate.
I’ve been thinking about a metaphor for it for a while and this is what I’ve landed on. I love a blanket. I always have one to snuggle under when on the sofa. On cold days, or when I’m feeling particularly challenged, I may even layer up with two, for that extra level of comfort. There are some parallels with the parts of my job I find comfortable, such as how I feel about responding to the crisis management part of IPC. It’s what keeps the job interesting and never dull. Right now, though, I feel like I’m lying on my sofa and the blankets just keep on being added. At first I moved from comfortable and snuggled to overly warm and uncomfortable. Now, with the constant piling of new ones, I feel like I’ve moved to suffocating and trapped. At some point you wonder how many can be added before you’ll never be able to escape from under the pile.
I think one of the reasons for this is not just the work but that, suddenly, life outside of work is now also work. Every conversation you have is about SARS CoV2. Conversations with friends, Facebook posts, taxi rides. When you have a bad day at work normally, at some point, you can walk away from it. There’s been no walking away from this: it’s everywhere and so there’s no space in which to recover.
The Clear and Present Danger
One of the other layers to this is the fear. It’s not something I dwell upon. It’s something I try to actively not think about, but there’s no denying it’s been an ever present feature of the last year. I posted about the fact that my sister passed away some years ago, so my parents and family have already been faced with losing someone. This is something that families don’t get over. What I haven’t posted about is that viruses and I have a rather turbulent past. I’ve been ventilated when I was younger due to acute respiratory distress brought on by viral infections. Viral infections also exacerbate my angio oedema, which makes my face and hands swell and impacts on my ability to eat and sleep. There has been understandable concern from friends and family about me needing to travel on public transport and attend work, whereas they would have loved for me to be able to stay home and build walls of protection around myself. Seeing that anxiety has not been easy. It has also not been easy ignoring that nagging fear at the back of my own mind. The ‘what happens if’. I’ve had to put faith in my ability to be super-compliant and in the guidelines I was issuing to keep both myself and others safe. This is always the case, but there’s no doubt that this has been a high consequences event if I got it wrong. Normally, when you are managing an outbreak, you are not also part of the outbreak.
This has been brought home by the deaths of colleagues and family. My family, like many others, have lost people as has my Trust. So you don’t have to hypothesise about how others are feeling. I’m feeling it too. The grief, the loss, the fear. There’s no walking away. The only thing you can do is acknowledge it, then straighten your shoulders and, as they say, ‘Keep Calm and Carry On’.
Everyone’s an Expert
One of the things I’ve found personally frustrating, no matter how understandable, is that everyone is now an expert. They appear to all have an in depth understanding of diagnostics, of virology, of infection control and of public health policy. I completely understand the drivers for this: it helps people feel in control, but even so it’s still super frustrating. The worst ones for me are the people who are definitely on the Top of Mount Stupid in terms of levels of knowledge. There was a lot of social media commentary on every action taken. Especially by people who others look to as being informed due to them having good levels of general knowledge. People who others will then take advice from without fact-checking or understanding that this is a complex situation with a lot of moving parts. As much as these people are often certain they are correct, it is also a certainty that they definitely don’t have access to all the facts, as even working within the system I couldn’t claim to have access to everything. At the start, I spent a lot of time trying to counter this misinformation but, as time goes on, I must admit I’ve struggled to have the energy. I think this has not helped in getting scientific messages out there and good communication, as many people involved are also maxed out on other actions. This guilt adds another blanket to my pile.
Real Science vs Movie Science
Although people normally smile and ask polite questions about what it is I do, I’ve never felt it has been in any way mainstream. It has been fascinating to me seeing decisions and things I’m doing in real time playing out in the media a day or two later. Early on, guidance and diagnostics were changing every few days or weeks. The speed at which everyone needed to flex and respond to changing demands and new information is something I have never experienced before. For me, on the ground, this was an amazing feat. But the criticism of speed and response does make me think of scenes from Star Trek, where you can get more just by saying how urgent it is: the implication being that we just aren’t working hard enough. The same can be said of individual sample requests. Sometimes when you get a call and someone explains how urgent a result is and the only response you can give is that the process is limited in speed by the underlying chemistry, it therefore cannot go faster no matter how much I want it to. There are certainly speed savings in workflow but these require workflows not to be changing every other day for you to truly understand where speed can be gained without impacting quality.
Reality Strikes and It’s Not Pretty
This all brings me to the thing that I have found most difficult. Seeing the response to the science. Not only in terms of protests in the streets from people who believe that the virus that has killed their family and colleagues doesn’t exist, but seeing the non-compliance with measures to save lives. The living reality of seeing how ‘the needs of the many outweighs the needs of the few’ plays out in the behaviour of both strangers and friends. The reality is that the scientific conspiracy theories have been present everywhere. What would, in other scenarios, have been chats that caused me to roll my eyes about data manipulation, vaccine hesitancy, and refusal to take personal actions lead to a different level of impact when it is all you are living and breathing. It’s not discussing hypotheticals when you are exhausted and dealing with sick people every day and experiencing personal loss.
I’ve found this super hard when these conversations and behaviours are displayed by not just strangers on the internet but by friends and family who you would otherwise have thought of as being part of your ‘tribe’. Part of the discomfort in this is that you are constantly faced with the failure to get sound information out there, and of your personal lack of energy to engage. I’ve also, on occasion, been attacked for being the bearer of bad news when trying to expectation manage on my personal social media. It means that, as of right now, I feel I will come out of this with some permanently altered relationships as it’s just not that easy to forget and move on. This will be a personal legacy of the COVID-19 pandemic that I will be dealing with for some time.
So Why Am I Telling You This?
A good friend, when I was talking some of these thoughts through, suggested I share some of this. Not just to talk it through, although that has been useful, but also to explain why I’m not excited about the so called ‘return to normal’.
Everyone’s journey and experiences over the last year have been different. Mine, like many people, has been one of exhaustion and stress, but not for the same reasons. A lot of stress discussed with me by others has come from feeling isolated and scared about personal well-being. Due to that some people, now they are vaccinated, are feeling less at risk. They are also understandably energised by the thought of seeing friends and family.
I on the other hand am in a much worse physical place than I was pre-pandemic as the stress has exacerbated everything somewhat. I’m also really tired and feel like I’ve been running non-stop for over a year. All I want now is to hide away and recover, see no one, and sleep until I am more like me again.
So please understand, if you invite me to things post-lockdown end, or if you phone and I don’t answer, it’s not because I don’t value our connection. It’s because I value it enough to want to engage again when I can be fully present. Until then forgive me for retreating back to my sofa and trying to get back to having one blanket that brings me comfort, rather than 150 which make it hard to breath. See you in 2022.
This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.
Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.
This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme
Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.
How Did We Get Here and How Does the Testing System Work?
When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).
The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.
Tests in the UK are carried out through a number of different routes:
pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
pillar 2: swab testing for the wider population, as set out in government guidance.
pillar 3: serology testing to show if people have antibodies from having had COVID-19.
pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:
Accuracy and reliability of tests.
Getting the right supply of people, lab space, equipment and chemicals.
Logistics.
What Points Did the Panorama Programme Make?
The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.
The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).
The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.
Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:
Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:
establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
sustains high-quality employee performance.
In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.
The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?
Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?
It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.
Staffing and Training
Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.
Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.
This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.
Quality Monitoring
In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?
Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.
All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.
To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.
So Where Does that Leave Us?
Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.
These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.
As stated in the programme: ‘If we’d spent the money supporting the existing system we would have been better off’
That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!
As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.
The set up is this. I was asked by Agata at Life Drawing+ if I would be interested in posing for her life drawing class where they were drawing images of key workers. She was after a virologist but I thought I might do 🙂 (she was given my name by an SfAM committee member – the importance of networks!) I had to decide on a pose and a song that summed up the pandemic, and then login to a Zoom call where we would chat and the artists (of all abilities) who were in the class would have 15 minutes to sketch.
I’ts now 7:30 Sunday night and I need to log into the zoom. I’ve been working all weekend trying to answer enough emails in order to keep my head above water. So why in the words of my sage and constantly supportive husband are we setting up lights and computers when I’m too tired to eat in order to pose for a life drawing class?
Why do I continue to say yes when I could say no?
Now don’t get me wrong. When I’m feeling as tired as I am, I often also ask myself that question and so I want to take you through some of the reasons that I continue to say yes.
If the Past Few Years Have Shown Me Anything, It’s That I’ve Only Got One Shot
Some of you may know that in my family this generation we’ve had a number of us not make it to 40. If anything, the pandemic has crystallised for me that we never know what’s around the corner and no matter how much we plan the next steps, fundamentally a lot of things are outside of our control.
For me, this means that I want to be able to seize new experiences and the learning they bring, rather than assume that there will always be another opportunity around the corner.
A one off event where I said yes to a public engagement event led to me meeting Nicola Baldwin and gave birth to a partnership that is now in its third year, has won national awards, and involved thousands of patients and members of the public. Building networks is done one interaction at a time So without saying yes you will miss out on further opportunities you didn’t even imagine were possible.
I appreciate this sounds like FOMO (fear of missing out) and if you take it too far it could break you, and that’s not what I’m encouraging. Its about really evaluating each opportunity offered to you and reflecting on the uniqueness of the opportunity, the possible outcomes and the reasons for saying yes or no.
I Want to Do Things that Scare Me
This leads me onto item no.2. I want to do things that scare me. Not ‘horror movie’scares me, but stepping out of my comfort zone. I really do believe that the best learning occurs when we are comfortable, when we are in the zone just outside of comfortable, where we are pushing ourselves. I’m naturally a pretty lazy person. If I could live my life as a Jane Austin character, drinking tea and reading books all day, I would. I’m super aware of this so, I make active choices to try and push myself.
Although I’m mostly hoping to have finalised the period of formal education in life, I really do want to still develop as an individual and each time I do something new and challenging I learn a little bit more about myself, be that stand-up comedy or modelling for a life drawing. If I hadn’t taken part last week, I wouldn’t have reflected on the question why and I wouldn’t therefore be writing this blog.
I Want to Raise the Profile of My Profession
One of my constant reasons for saying yes is that I work in one of the best professions in the world, and no one seems to know that it exists! I am very aware that if we do not get out of our bubbles and talk to people then everyone will continue to believe that the NHS consists solely of doctors and nurses. We won’t inspire the wonderful future workforce to become Healthcare Scientists rather than taking the more traditional route of entering medicine. After all, you can’t be what you can’t see.
For me, one of the things that I get asked about most is swabbing, how to do it, what it means. It’s one of the things I’ve done most of, both myself and being part of strategic planning. So when it came to deciding on a pose I went with using lateral flow equipment and (the top half) of my scrubs.
I made a very deliberate decision not to pose in a white coat with a pipette as I wanted to encourage conversations that show that so many Healthcare Scientists don’t work in a laboratory and to talk about the amazing work my colleagues have done during the pandemic. We spoke about ventilator technicians and biomedical engineers, cardiac physiologists and lung function. As well as pathology and the importance of diagnostic stewardship.
I Want to Talk About Science with People Who I May Never Encounter Normally
You may have a really wide social circle normally, but no matter how wide our circles we still tend to be limited in the people we interact with. Most of my friends work in IT, law, finance, medicine or science. I have a few writer friends but my artistic creative circle is most limited to the lovely creatives I’ve met through working with Nicola Baldwin on projects like Nosocomial. Right now it doesn’t even really matter how wide your social circle normally is, if you’re like me it’s currently focussed on a few really key people in your life. Lockdown and exhaustion from work make it hard to have the energy to be truly social. I think we have to understand therefore that our understanding of the world and of the challenges are coloured by those interactions. Something really brought home to me by recent elections and the way that COVID-19 conspiracy theories spread. If we really want to have an impact and understand the barriers to undertaking science, and how science is perceived, we need to have conversations outside of our echo chambers. We need to engage in true dialogue that will often challenge us and sometimes scare us.
It is both invigorating and eye opening to see your profession through the lens of people that do not necessary have access to scientists. It makes you realise that some of the things you take for granted, for me children ending up in ITU due to SARS CoV2, is not something that is necessarily in the general circulating knowledge.The perception that children don’t get SARS CoV2 is strongly pushed both in the media and political statements, even if what they actually say is more nuanced. Being open and willing to truly discuss, answer questions and embark in creative thinking about topics both normalises science, and also benefits me by supporting me to see challenges in a new light.
Finally, look at all the amazing one of a kind mementoes I got out of it: items I would never have otherwise. So next time you get offered that unique opportunity remember to think yes, rather than automatically saying no.
It’s recruitment season in both Healthcare Science and academia right now. Many promising young scientists have applied for the Scientific Training Programme, whilst others are applying for PhD positions and taking their first steps to becoming independent researchers. I’ve been having lots of conversations and I’ve been getting lots of emails/tweets about what I would be looking for as part of this process. I’m also going through a recruitment process myself and so this has been on my mind. I’m going to share what I look for, but I want to be very clear this is just that, what I look for. Others may have different opinions and so it’s always worth canvassing more than just one person as there are people out there who are experts in this.
There are obviously two big sections to this, the application process and the interview. If you get to the interview then you will have got there because I believe that you can do the job. At that point it’s about team dynamics and shared vision and it’s as much about you interviewing me as it is about me interviewing you. So for this post I’m mostly going to focus on the application process and getting that foot in the door.
When you are applying for a post you will have access to a whole bunch of information, some of which will be more apparent to you than others. There will be names listed, names of specialisms, names of the recruiting staff, all of which will give you a clue as to how to get information on the type of people who will be interviewing you.
Getting to know more about the people involved in the recruitment process will help you prioritise the information in your proposal. Is the Trust and department you’re applying to research active? If not then you might want to use that word count about your undergraduate dissertation for something of greater interest to them. For STP applications you should include reference to the fact that you’ve spoken to people who work in the field to demonstrate an understanding of the job. For PhD applications make sure you include specific references to the papers the hiring academics have recently written in your cover letter so you have shown you know who they are. This enables your to start out building a relationship with the people who are shortlisting, they know you’ve taken the trouble to know more about them and it’s a sign of respect that will stand you in good stead.
DON’T do what once happened to me when I was interviewing a male candidate. The panel was entirely female and the interview was going well, the candidate obviously had done his homework on us. The last two questions blew it however. We asked him about research experience and he proceeded to tell us that he had looked up our work and how he could guide us in doing it better. He then followed up when asked if he had any questions with ‘When will you let me know I have the job’. Needless to say that call never came.
Do Your Research
Following on from knowing your audience is doing your research. I’m going to be super honest here. When I applied to be a clinical scientist I kind of knew what it was but I wasn’t super confident. That was because there weren’t the resources out there to give me more information. That is no longer the case and there are a lot of internet resources available. This means that if you’re applying for this kind of post now it is expected that you will know not only about the job, but also to have defined answers about why you want to do it and why you are suitable for the post.
For PhD positions doing your research is even more important. I want it to be clear on your application why you want to do this particular PhD. What is it that attracted you to the topic, what work have you already done in this area, what reading have you done to demonstrate your interest. The one thing that many candidates don’t come with to the interview that makes them stand out is what questions their research on the PhD so far has raised in their mind, what questions are they are interested in asking. Even during the interview I want to see the scientific curiosity that will make you a great scientist and separate you from your competition.
DON’T send me an application that is generic and hasn’t been personalised for the position. If you can’t put in the effort to research the post and personalise your application then I won’t put in the effort to interview you as it will feel like you’re not really that interested.
Obey the Rules
In every job advert there will be information and guidance about how to apply. You would be super surprised at how often applicants don’t pay attention to the guidelines. Now most of your scientific career will require you to apply for things, business cases, grant funding, conference attendance etc. If you can’t demonstrate the care and attention to detail when applying for the post it indicates that you may also not adhere to the guidance when applying for these other things, directly impacting your chances of success and career progression. I’m all for individualism and for thinking outside the box, but an application process is about enabling me to do a side by side comparison, which I cannot do if you side step what’s requested.
For NHS posts you need to be demonstrating in the personal statement section what is asked of you in the job description (JD), as this is what you will be scored against. If you don’t cover the points then you cannot get the marks required for short listing. Also pay attention to where you are expected to demonstrate the skills, knowledge etc. It will usually say whether it is on the application, or during the interview. If it stated during the interview and you are limited on words use them to tick the ‘demonstrate in the application’ boxes. Also use the ‘demonstrate in interview’ descriptions as a hint to what questions you are likely to be asked during the interview process.
For PhD posts make sure you send what you are requested, make sure that your cover letter contains the information requested in the advert and that your CV reinforces your key points.
DON’T send a CV to an NHS job application and miss stuff off your personal statement as I won’t look at it. If you’re applying for an academic post don’t just send a CV without providing the information specified in the advert as I won’t look at the CV if I consider your application incomplete.
Know Your Unique Selling Point (USP)
When I applied for my trainee clinical scientist post there were 240 applications for 4 positions. The scheme has only got more competitive since then and PhD positions can be equally if not more competitive. Although interview questions will vary across post types you will almost always get asked why you? Why do you want this post? Why are you suitable for this post? How will this post get you where you want to be? What is your 5 year plan?
It is therefore worth taking the time to think about what it is that will enable you to stand out from the competition and make sure that you have clearly stated it in your application. Are you applying for a PhD post and already have published papers, got a travel grant or partaken in science communication activity? Make sure that it is there and easy to see, as this will enable you to stand out from the field.
Are you applying for an STP post and have already done work experience in a clinical lab, worked with patients or have a lived experience that could help you? Make sure that this is clear as it will help during the short listing process.
Remember that for both PhD and STP positions they are effectively graduate training schemes. These are first steps in a career that will last a lifetime and so knowing where you want to go on that journey is important to both know and to communicate to your recruiters.
DON’T hide the things that could make you stand out. Think about what your USP is and make sure it is clear and easy to find. The person trawling through these applications is unlikely to have the time to read every line you write and so make sure you grip them in the first couple of paragraphs so that they will keep on reading.
Make It Easy
This year for the STP programme there are over 6000 applications to shortlist. I have had to go through over 150 applications for PhD programmes before now. I would like to say that I always have the time to give each application the time it is due, but the honest truth is that I am trying to make this work on top of a very busy clinical job. You’re application therefore needs to stand out and be really easy to process.
For NHS applications that means using the terminology used in the JD I am scoring you against, ideally using sub heading and bunching information together so I’m not searching for whether it is present in your personal statement. It also means that if it is key information I would include it in more than one section so I’m less likely to miss it.
For PhD applications it means being very explicit in your cover letter showing that you have: an interest in the topic, that you have researched linked to the work and why you want to undertake this specific PhD. It also means making the information in your CV related to the PhD proposal really easy to find. Don’t put down every technique in the world if only 25% of them are applicable to the topic you’re applying. List in detail the relevant ones and the group the rest and bring them up at interview if appropriate.
Put your USP up front and clear, put it a box, underline it, give it it’s own paragraph or sub-heading. Do something to make it easy to see when your application is being skim read.
DON’T send a 150 page CV containing every certificate you’ve ever achieved. I will just toss it on the no pile without reading it.
I want to wish everyone the best of luck in the posts you’re applying for now and in the future. Remember every job is different and you will obviously want to tailor some of these tips to whatever you are going for but my top tips are:
Personalise the application
Say who you are and why this is the post for you
Read the application notes carefully so you give the short listers what they are after
Make it easy for whoever is looking at what you submit by using techniques such as sub-heading so the information is easy to find
Become familiar with the people and organisations you are applying to so you can tailor what you are writing
Healthcarescienceweekis an annual celebration to raise awareness of the many careers inhealthcarescience. It provideshealthcarescienceprofessionals with an opportunity to promote their profession and inspire the scientific workforce of the future.
More than that however, it provides us with the opportunity to talk about what we do or issues that matter to us with members of the public, our friends, colleagues in other healthcare professions and our families.
This year Healthcare Science Week runs from March 6th until 14th March. The Healthcare Science Education team at GOSH and our collaborators Nicola Baldwin and Dr Steve Cross have three awesome events planned across the week, with something for all ages and backgrounds.
Welcome to Healthcare Science Week 2021! Depending on how I feel and how busy this week is I’m hoping to post a few times and to make up for not posting much recently as I’ve been unwell. Also, as I’ve been not well I’ve had plenty of time to reflect on the importance tea has in my life. My husband is a sweet heart who makes me many a cup and it is my place of comfort and salvation when the world gets too much. It is also a place of reflection and helps me do my best thinking. So this post is devoted to one of my favourite things in the world and something that helps me be the best scientist I can be…………..a lovely cup of tea. (NB for me this is ideally a cup of Darjeeling or Lady Grey served black. You can I am sure substitute it with your favourite, or blasphemy, even exchange it for coffee).
Tea and Planning
Most of science is not actually in the doing, most of the best of science is actually in the planning. If you get that right then everything else will follow. If not you can spend a lot of money getting a lot of data that is in fact not much good to anyone and definitely doesn’t answer the questions you were asking. When I was starting out, and sometimes even now when a deadline overwhelms me, I thought it was better to be doing. To be in lab getting ‘somewhere’. Needless to say I spent a lot of time getting ‘somewhere’ but that wasn’t where I needed to end up. Tea cannot be drunk in the lab. Sometimes making a cup of tea therefore is a really good way to break the cycle of doing and force yourself to have time to step back and plan. It is one of the reasons I have exceptionally large cups as they give me the time to get into the right headspace and adjust my thinking before I reach the end. It also helps that I drink my tea black so that it also has cooling time. By the time I’ve cooled and finished my mind is usually in the place it needs to be and I’m in planning mode not panicked doing mode.
Tea and Networking
I believe it is no secret to anyone that reads this blog that I appreciate a piece of tea and cake. This is partly because I like to host as it gives me a structured way to talk to other people. It is also because I believe that when we are sitting and eating/drinking with other people it removes hierarchy, especially if that can be done outside of the usually work environment.
This next but may shock you, but I HATE networking. I’m pretty good in 1:1 situations where I know the other person, but I’m rubbish at faces and I’m even worse at remembering prior conversations. It’s definitely not the fault of the person I’m speaking too, it’s just my memory doesn’t work that way. My memory is super context specific. I therefore find the horror of speaking to people who know who I am, who I have spoken to before and me not remembering, one that I regularly encounter. I also hate networking as I actually have no small talk. I spend a LOT of my time working and my geeky hobbies are not ones that many people will engage with on first meeting and so I struggle. It’s one of the reasons I started on Twitter almost 20 years ago. Twitter meet ups at conference meant I had already done the small talk and we already had shared context and so I didn’t have that panic inducing moment where I tried to find something sensible to stay (NB this is still a top tip of mine if you’re starting out going to meetings).
Tea makes me relax. At conferences I can always talk about the food and the tea. It also means that I worry less if I’m talking to a Noble prize winner or someone of international renown. They need to eat and drink just like I do. Also, if you find someone hanging around the tea area with no one to talk to they are probably in the same boat as you and will be super relieved that you are the one that made the conversation opener so that they didn’t have to.
Tea and Sympathy
For all you amazing young scientists starting out please don’t take this one too much to heart, but use it a short cut to help your mental well being. Science is 80% failure. You will fail at grants, you will fail when you submit papers, you will have bad supervisor meetings and elevator pitches and most of all you will have failed experiments. Sometimes in the case of lab work these failures can go on for months or years and be super costly, both in terms of money but also in terms of your mental health. What you need to know now is that this is normal. The most amazing scientists you meet will have sat there in a puddle of tears with mountains of self doubts and fear that nothing would ever succeed again. No one ever sat me down and told me this. For a long time I felt I was alone in the failure. Then over time my colleagues became friends and we finely got to the point where we could voice our fears and disappointments. Only then did I realise that I wasn’t alone. That these failures were crucial points where I learnt and developed and that instead of fearing them I should embrace them.
So my advice now, for all those I supervise and support, is to spend time early developing a few key relationships. Then when you are experiencing the failures you too can have someone who will listen and tell you that it’s normal and support your mental wellbeing as well as helping you get back on track. You will also learn from being the person who supports others when it’s your time to pull out the tea, biscuits and box of tissues.
Tea and Reflection
Moving on from tea with others I wanted to reinforce the importance of tea with yourself. This touches on the Tea and Planning section above but is wider than that. As scientists with are often process driven and tend to be rather task orientated. That means we are great at getting things done but poor at working out why we are doing them. Working as a scientist these days is super complex. Not only are you dealing with regular failure, but you are dealing with complex political environments and career pathways that are anything but clear. When we fail to give ourselves time to reflect and check in with ourselves we can end up going down rabbit holes that don’t get us where we want to go. It also means that our relationships suffer. As you gain students, direct reports and more leadership responsibility it it really important to think about why certain conversations went the way they did. To reflect on things like your leadership style and which situations it’s working in and which it isn’t. As trainees it’s worth taking time to think about why you didn’t get the supervision support you were looking for, did you pick a bad time, did you not manage to articulate what was needed etc. Only by working on ourselves can we really move forward, and this is the one thing we often don’t take the time to consciously do.
Tea and a Pep Talk
So you might say to me ‘what is the different between tea and a pep talk and tea and sympathy’. I would respond that they are actually very different things and both have their place. Tea and sympathy isn’t about trying to ‘fix’ things, it’s about centering yourself when things are going wrong and not feeling along. Tea and a pep talk is more like a coaching experience, It’s about someone giving you constructive support to help you navigate a challenge. It requires a bit of work from both parties in order to try and progress the issue and although it should also enable you to come out feeling better, it should also enable you to come out with a plan of action. You may not be needing a pep talk because you’re upset but because you have a barrier to traverse, a conversation to have, or a direct to pick. You may also want your pep talk to be from someone different to your tea and sympathy as it may be that you want to access knowledge or experience. It is often a conversation that is not so reliant on trust as your tea and sympathy chat may be and you will want to bear that in mind when picking who to have these conversations with. Having tea in these conversations often means you can change their location to outside the working environment (if needed) but also set them up to not be rushed and have the time needed to reach the destination required.
Tea and The Late Night Session
I’d like to say that I have this work life balance thing cracked, but I suspect that my family, friends and colleagues would say that probably isn’t the case. Even if I has I think there is no way of getting around the fact that if you work in science there are going to be some late nights. Sometimes that’s because you are doing a growth curve that is going going to take you 20 hours, sometimes it’s because you have a full working day and then need to do some work for a dissertation and sometimes it’s because of some form of urgent need that means you need to start something for a patient at 6 when you were due to leave at 5.
I used to try and just push through these sessions. I used to think that finishing as early as possible was the best way to balance it with everything else. What I learnt is that when I pushed through I made mistakes. I learnt that for me even when pushing to get things done I need to schedule short ‘walk away’ periods where I could have a cup if tea and move in order to think, especially if I was at work beyond 8 o’clock. Otherwise I made silly mistakes, For the sake of transparency sometimes these wake up ‘walk away’ sessions involved me dancing across the lab with tubes in hand to Lady Gaga, but mostly they involved a cup of tea and ideally a biscuit as I wouldn’t have eaten. My practice is to give myself a 5 minute break to make the tea, go back and do another 20 minutes whilst it cools and then to have a 15 minute zen moment whilst I drink it. I’m sure you will have your own method, but developing one with save you errors and stop you having to repeat these late night efforts.
Healthcarescienceweek is an annual celebration to raise awareness of the many careers in healthcarescience. It provides healthcarescience professionals with an opportunity to promote their profession and inspire the scientific workforce of the future.
More than that however, it provides us with the opportunity to talk about what we do or issues that matter to us with members of the public, our friends, colleagues in other healthcare professions and our families.
This year Healthcare Science Week runs from March 6th until 14th March. The Healthcare Science Education team at GOSH and our collaborators Nicola Baldwin and Dr Steve Cross have three awesome events planned across the week, with something for all ages and backgrounds.
The Pub-Less Healthcare Science Pub Quiz! Join professional silly science person Steve Cross for a special quiz full of jokes and nonsense, just for the Healthcare Science community.
The questions will be fun but relevant, the special tasks will be ridiculous but possible, the marking will be loose but decisive and the prizes will be exciting but unspectacular.
As part of Healthcare Science Week 2021, this is an event to give healthcare scientists a chance to have a night of fun and relax.
Reading of SOCK the Puppet Play & Public Engagement Panel (Thursday 11th March – 18:00 – 19:30)
We invite children, families, Healthcare Scientists and creatives to celebrate Healthcare Science Week 2021 with our story of Sock, narrated live on zoom by Stephanie Houtman (Peppa Pig Live), directed by Saskia Marland with special appearances by Sock.
Followed by a Healthcare Science Week Q&A about Sock’s story, the opportunities and challenges of science-arts collaboration, and why public engagement matters in 2021 – with Nicola Baldwin (writer), Stephanie Houtman (actor), Saskia Marland (director), Abi Bown (maker) and Healthcare Scientists Vicki Heath and Dr Elaine Cloutman-Green BEM, Lead Clinical Scientist at Great Ormond Street Hospital.
Full Reading of SOCK the Puppet Play (Friday 12th March – 11:00 – 12:00)
Meet Sock, the puppet. Sock is excited to go and sing for the children in Hospital with Ms Clown. Sock loves the Hospital. It is always clean and tidy.
The children love Sock’s singing. All the children hug Sock.
When Sock catches all the bugs that make the children poorly, Sock has an adventure to the cleanest, tidiest place in the whole Hospital: The Laboratory.
Can you help Sock find a way back to Ms Clown and the children?
Join us to celebrate Healthcare Science Week 2021 with the story of Sock, narrated live on zoom by Stephanie Houtman (Peppa Pig Live), directed by Saskia Marland with special appearances by Sock.
After you book tickets, you will receive a worksheet to make your own Sock at home, designed by artist and maker Abi Bown.
Created by the team behind Nosocomial and Remember, Remember! – playwright Nicola Baldwin, and Healthcare Scientists Vicki Heath and Dr Elaine Cloutman-Green BEM, of Great Ormond Street Hospital.
Sock The Puppet will subsequently be available as a podcast.
Do you know what everyone in space is scared of? It’s not lasers (we’ve got shields) or fire (we’ll just get a droid to put it out) or even fifth-dimensional beings (they can be defeated by being witty or saying their name backwards). No. It’s torpedoes. Well, in Star Wars and Star Trek it is. I don’t know about Battlestar Galactus or Paddington 5 or Expansys or whatever it is that you like. I only know the classics.
Torpedoes come in two types. Star Wars has proton torpedoes (if you fire one into a sewer it ignites all the old poop and makes it destroy the whole base) and Star Trek has photon torpedoes (these are often fired as a “full spread” which implies there are roasties, Yorkshire puddings and possibly pigs in blankets on the side).
But how scary are they?
Science can tell us.
A proton, as anyone who listened for 5 seconds in GCSE science knows, is a hydrogen ion. Basic boring old hydrogen is a single proton with a single electron floating around it. Take the electron away and you’ve got protons. Do you know what’s really rich in protons? Acid. Even a really weak acid has trillions* of spare protons in it.
Canonically we don’t know whether Star Wars torpedoes have a warhead of lemon juice, vinegar or possibly even Viakal. Sadly there are no scenes of brave flight technicians precisely measuring teaspoonfuls of Diet Coke into primed torpedoes. What we do know is that the torpedoes would definitely get the limescale off their targets with their rich proton loads. Star Destroyers probably shine like chrome after a good old space battle.
We can only speculate about how the first Death Star was destroyed. Did it have a core made of millions of tons of sodium, just waiting to recreate the most exciting moment of A-Level chemistry but at grand scale? Only Darth Vader knows. And he can’t tell us because he isn’t real.
Over in the Star Trek universe we’re all wearing our uniforms that are apparently solely designed to make cosplaying unsexy, and we’ve tried shooting the enemies with phasers (the first time I used the guitar pedal of the same name I was sorely disappointed). It didn’t work. It usually doesn’t. Phasers only exist to provide a moment of tension by not working. So it’s time to up the stakes. We will unleash the fearsome photon torpedoes!
In tedious-science-explanation land, a photon is the smallest possible unit of electromagnetic energy. It is the basic unit of light. Photons move pretty fast, in fact they move at the speed of light. That’s why it’s called that. Physicists are pretty literal. That’s how they came up with units like “Light-year (ly)f” and “Earth mass (M⊕)”.
It’s easy to blast your enemy with literally trillions* of photons; Just point a torch at them. Is this the payload of the fearsome photon torpedo? We know they’re big enough to fit a dead Vulcan in, ears and all (from the second movie) so they could hold some serious lighting. “Priming photon torpedoes” presumably means turning on all of the torches in each one by hand. Although, if all those torches had poorly-made lithium batteries and it got a bit warm, the photon torpedo might make a perfect incendiary bomb.
Is anyone else not scared? I’m not scared.
*It might be more. I refuse to do the maths.
APPENDIX
A dismissal of the other forms of Star Trek torpedo, most of which only appear in one episode of Voyager when the writers were desperate because, against all the odds, Deep Space Nine was eating their lunch. It turns out we just wanted to see someone drink silently at a bar while Worf seduced every female character on a space station. Who knew?
fusion torpedo – This is what is known in normal human history as a thermonuclear or H Bomb. This is scary shit. It was also invented in the 1950s which suggests other cultures should have come up with a way of blocking it by now.
photonic torpedo – A more-sciencey-sounding version of a photon torpedo, presumably.
plasma torpedo – I’m assuming this is full of ionised superheated gas, not human blood with the cells removed. I’m not sure how scary that would be to anyone except a vegetarian. Less threatening than a fusion torpedo either way.
quantum torpedo – the smallest possible unit of torpedo
spatial torpedo – a torpedo that is used in outer space? Or that occupies some physical space? It doesn’t seem that scary. Or well named.
transphasic torpedo – I’m not sure why anyone would want to add phasers (which don’t work, ever) to a torpedo?
gravimetric torpedo – Uh oh look out this torpedo has mass!
NB from Girlymicro. If you’d like to submit a guest book review or guest blog drop me a line on the links on the right of the page
Paid-up member of the Dream Team since 2013 (as discussed in a previous post, in her personal life most people call her Girlymicro Dream), token immunologist and occasional defector from the Immunology Mafia. Registered Clinical Scientist in Immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln.
A clinical immunologist’s thoughts on lateral flow antibody testing – this post follows on from Dr Dream’s awesome post on testing for the virus – concerns my thoughts on COVID-19 antibody testing by lateral flow technologies.
‘The LEDs on the top of the box turned on, one red, one green, beginning to flash in an alternating patter. The flashing slowed and finally stopped as the red light went out, leaving the green. Still clean.’
Whilst some days it might feel like the end of the world during the COVID19 Pandemic, we aren’t quite living through the zombie dystopian vision of the future described in Mira Grant’s Feedback trilogy. However, much like in the world envisioned in Feed, point of care testing has become part of many people’s lives. A friend recently received a lateral flow anti-SARS CoV-2 antibody test and sent me his result saying, “turns out I never had it, 80-90% confident”. It sounds like quite good odds, doesn’t it? If you happen to like gambling, and someone told you to bet on a horse with an 80-90% chance of winning, it’d be tempting to have a flutter. But when it comes to clinical testing, a 1 in 5 chance that that result is inaccurate is far less appealing.
What are the tests?
Antibody tests, unlike testing for the virus itself, detect the antibodies produced by our immune systems in response to infection. To envisage a lateral flow test, think about a pregnancy test. Instead of urine, a few drops of blood from a finger prick are mixed with a solution and applied to the device.
You then wait 10-15 minutes and the results can be read in the result window (image 2). There are many different versions of these tests out there, but the underlying principle is much the same. If you have the antibodies in your blood sample, they bind to viral proteins attached to gold particles. This forms an antibody-antigen-gold-particle complex which can be seen as the positive test line.
How good are the tests?
‘Confident’ isn’t a term we like to use in clinical science: we like the terms ‘sensitive’ and ‘specific’. We also like to use statistics to describe the sensitivity and specificity of a test. In the case of COVID-19, the sensitivity of the test is the proportion of people with COVID-19 that have a positive blood test. A test which is 100% sensitive means that all individuals with COVID-19 are correctly identified as having the disease. Conversely, specificity is the proportion of individuals without COVID that have a negative blood test. A test that is 100% specific means that all healthy individuals are correctly identified as not having COVID-19. It’s pretty hard for any clinical test to be this wonderful, but we are trying to get as close to this ideal as possible. The MHRA recommends these tests have a sensitivity of >98% and specificity of >98% (1). To date, none of the lateral flow assays to detect antibodies have met these criteria.
What are we using them for?
Testing for antibodies isn’t the same as testing for virus. A positive result means you were likely infected with COVID-19 in the past. This result should not be used to diagnose a current COVID-19 infection because it can take 1-3 weeks after infection for your body to make antibodies. We aren’t sure how long these antibodies are going to stick around either. Some viruses are very memorable to the immune system. Unfortunately, coronaviruses are pretty forgettable, and the ‘immunological memory’ – the antibodies against the SARS CoV-2 virus – may disappear in a matter of months. In the case of my friend, who took his antibody test in October to find out if he had COVID-19 in February, that negative result doesn’t mean very much.
This test only tells you that you’ve made antibodies to the virus, not how many are there and if they can stop reinfection. We don’t know if these antibodies are protective or if that makes you immune to the virus. You can also test positive for the virus and positive for antibodies at the same time, meaning you are still infectious. Best not to use the result to decide whether or not to visit Grandma.
The Bottom Line
Whilst I don’t love these tests for individual use, they are useful. By monitoring the prevalence of antibodies against SARS CoV-2 at a population level, we get a snapshot of what is happening in the country in the moment the test is taken. It tells us something about the antibody status of a community of individuals, helping to monitor the COVID-19 pandemic at a population level and more data will hopefully help immunologists better understand what on earth is going on with the immune response to this virus.
TLDR. Lateral flow tests for antibodies are best left for community studies and aren’t going to let you know if you had COVID-19 in January. You’ll just have to keep wondering.
I’ve been having trouble sitting down to read actual paper books for a while now. The pandemic has my mind kind of worn out and, although I always used to have 4 or 5 paper books on the go at one time, right now I don’t have a single one. That’s not to say I’m not still getting my fiction/non-fiction fix. It’s just that right now it’s happening via audiobooks as I can just close by eyes and be transported.
This brings me onto a slightly new thing I’m going to try out: reviewing and giving some love to books that have science within them to aid that escape rather than making me irritated. I read the whole of the Newsflesh series by Mira Grant a few years ago at the suggestion of the wonderful Dr Claire Walker. As part of my insomnia strategy, I’ve rediscovered it and my love for the science within it.
The Newsflesh series consists of three main novels: Feed, Deadline and Blackout, as well as some short fiction.
Mira Grant describes the premise of the novels as:
“The zombie apocalypse happened more than twenty years ago. Contrary to popular belief, we didn’t all die out, largely because we’d had years of horror movies to tell us how to behave when the dead start walking. We fought back, and we won…sort of. The dead still walk; loved ones still try to eat you if you’re not careful; the virus that caused the problem in the first place is still incurable. But at least we lived, right?”
Nothing is impossible to kill. It’s just that sometimes after you kill something you have to keep shooting it until it stops moving
Most zombie fiction is either set during the rising itself, that moment when the dead rise, or during a post-apocalyptic future where the worst of humanity is on display. Within the Newsflesh series, and especially Feed, this isn’t the case. It’s set 26 years after the rising in a world that lives with the ever present nature of having the undead on your doorstep. This is partly because of the way the rising occurred.
The Virus
As in most zombie fiction, the rising was caused by science that went wrong. In this case a modified virus known as Marburg-Amberlee (Marburg EX19), invented by Daniel Wells, was designed to cure leukaemia. It was first tested on Amanda Amberlee, a young leukaemia patient in Colorado, and it succeeded in curing her, after which it remained dormant in her cells and those of others given the cure. A second genetically modified virus was also being developed, known as the ‘Kellis cure’/’Kellis flu’. The aim of the Kellis cure was to provide a universal cure for the common cold. It contained a mix of coronavirus and rhinovirus proteins, with a fifth man-made protein that was designed to increase the virus’s ability to invade. When the Kellis cure is stolen from the research lab, where it is being developed by a group of activists who believe that this universal cure is being ‘held’ from the world and should be freely available, disaster occurs. The activists believe that the virus should be freely available to aerosolise the virus. The two RNA viruses underwent a combination event in those humans who had been treated with Marburg-Amberlee initiating a new infection, a virus now know as Kellis-Amberlee.
Now every mammal on the planet over 40lbs can convert into a zombie on reactivation of the latent virus in their cells. This can happen as a result of trauma, death or, like many latent viruses, due to failure of the immune system.
The World
This is the truth: We are a nation accustomed to being afraid. If I’m being honest, not just with you but with myself, it’s not just the nation, and it’s not just something we’ve grown used to. It’s the world, and it’s an addiction. People crave fear. Fear justifies everything. Fear makes it okay to have surrendered freedom after freedom, until our every move is tracked and recorded in a dozen databases the average person will never have access to. Fear creates, defines, and shapes our world, and without it, most of us would have no idea what to do with ourselves. Our ancestors dreamed of a world without boundaries, while we dream new boundaries to put around our homes, our children, and ourselves. We limit our potential day after day in the name of a safety that we refuse to ever achieve. We took a world that was huge with possibility, and we made it as small as we could.
I think we’re all living in small worlds right now, as I write this on the sofa during yet another lockdown. The think I loved when I first read the novels, and actually love even more re-discovering them in a lockdown world, is how society has adapted to answer the challenges of infection.
All areas of the country (it’s set in the States) are split into hazard categories. If you want to live in an outside space, where mammals could roam and it’s harder to control the movements of the walking dead, you have to accept higher levels of Infection Prevention and Control. Every car door has an antigen test that makes sure you are not in active viral replication before it will open so that you don’t risk fellow passengers. Every door into a home has the same risk. The world is split into those who have completely locked down and live for all intents and purposes an entirely virtual life. Whilst others, determined to have the right to maintain their freedom to keep animals such as horses, or other life styles choices, put their lives at risk to do so and also potentially risk others. Entire areas of the country have been declared ‘lost’, as the movements of the undead cannot be controlled. If you go into high-risk zones, all your clothes must be destroyed or, in less restrictive zones, sanitised whenever you leave the house. Every time you go outside you must be washed with dilute bleach on return. The rules are the law and following them is not supposed to be optional, although, as we are currently seeing, there are always those who will fall into the extremes of the two camps.
The Truth
The other thing that really resonates right now is the distrust of the media. During The Rising, the news is felt to have let down the public by being too much controlled by governments and institutions. The books themselves follow the Mason siblings, reporters Georgia and Shaun, as well as their news crew covering how a presidential election is run in this new world.
News is done differently in this new world because of the reaction to the number of deaths that were caused by the slow response of traditional media to covering the rapidly changing situation. Information is delivered by:
Newsies (of which Georgia is one), who aim to deliver neutral fact-based coverage of the news via blogs and websites.
Irwins (like Shaun Mason which are named after Steve Irwin), who seek to educate and entertain by going into areas that are off limits to non-reporters in order to give a true view of the world.
Stewarts, who aim to collate and curate the reports of newsies, pretty much a ‘one site for all things’.
Aunties, who share personal stories, recipes, and other content to keep people happy and relaxed.
Fictionals (like Georgette “Buffy” Meissonier), who write poetry and fiction in order to explore everything that has happened to humanity since the rising.
One of the things that I currently worry about is how we will rebuild the trust and faith in science that may have been damaged by science becoming so politicised during the current pandemic. Although, in many ways, we’ve also seen the damage that going to individual blogs and echo chambers can do to the concept of evidence-based science. Re-engaging with the series right now does make you think about how difficult it is to communicate widely, and how important scientists having conversations across boundaries is.
In (not so, this post is longer than it should be) short, if you haven’t read Feed then you should. Read it because the virology is sound, and the Infection Prevention and Control makes me super happy. Mostly though, read it because it may give you a different lens through which to see our current situation, as well as being super entertaining.
For those of you that know me only as Dr Cloutman-Green, you probably won’t know that, in my life outside of the hospital, most of my friends call me Dream. I’ve been called this since I was a teenager. I’d like to say there was a super cool reason for this, but the real reasons are twofold:
I have always had very vivid dreams and I have them pretty frequently.
Even now, but especially as a young child, I am/was so caught up in thought that I will/would tend to wander into things whilst walking: like lamp posts!
I got my PhD. Then a shy, retiring drunk from Birmingham – in a rare moment of sobriety – designed the Dr Dream logo as a gift and it’s kind of stuck.
During the last year I have not slept well and my dreams have been especially intense. I dream a lot when I’m solving problems and will often perform experiments or clinical scenarios in my sleep. In many ways these have helped me as they often lead to what I call my 3am ‘moments of clarity’: those moments when I wake up and I’ve finally worked out the solution to a problem or a new approach so I can see it from a different angle. The problem this year has been that those 3am moments are no longer ‘moments of clarity’, as the problems we’re facing cannot be solved by just me. They are too big. They are now 3am ‘moments of panic’ or ‘moments of frustration’.
In April I posted about a particularly strange dream I’d had and, via the magic of twitter, I was put in touch with Professor Mark Blagrove, Dr Julia Lockheart and the DreamsID team. The team are interested in how COVID-19 is impacting on dreaming. They have an amazing process, where Julia uses her creative skills to combine art and science in order to produce imagery of the dream onto pages from the first English translation of The Interpretation of Dreams.
The Process
The discussion of a dream follows the dream-appreciation method devised for dream discussion groups by psychiatrist and psychoanalyst Montague Ullman. Further information about Montague Ullman can be seen on the website https://siivola.org/monte/. The method is described in his 1996 book Appreciating dreams: A group approach (Thousand Oaks, CA: Sage). The method comprises the following stages: •The dreamer reads aloud their dream. •The group asks questions about the dream so that it is described as fully as possible. •The group members, except the dreamer, briefly describe how they would relate the dream to their own lives, as if the dream were their own. •The dreamer responds to what the other group members have said. •The dreamer describes their own life circumstances, with emphasis on recent waking life concerns and recent emotional or important events. •The dream is read back to the dreamer in the second person. •The group and dreamer make or suggest connections between the dream and what the dreamer has said about events and concerns in their recent waking life.
My Dream
The Setting
My office is a converted bathroom. It’s pretty small and still has a sign saying ‘bathroom’ on the door (in purple). It’s pretty small: it has room for one desk chair and an L-shaped desk across from the door and running down the right hand side of the space. It’s a totally white space with no natural light or ventilation. It has quite bright white lighting: an LED lamp on the L intersection that lights my main workspace where I work with my back to the door.
The Dream
In my dream, I am working at my normal workspace (the desk part opposite the door) in my desk chair, which is’ a ‘Bond villain’ desk, large and black mesh. Unusually, I also have the purple furry blanket that normally lives on my sofa across my knees. It’s trailing onto the floor, so I’m slightly trapped where I am. My desk is clear apart from the lamp of the normal bits and pieces, although there are still my post-it notes under the shelves above my head, which remind me of what I need to be doing, and my shoe a day calendar that sits in front of me on the shelving. Behind the lamp, however, the hatch that is normally solid and leads to the electrical space has a transparent door with a handle and looks like the pass hatch into a medical safety cabinet. On the left of me where my in-tray normally sits is now a scientific water bath, white outside, full and bubbling, with a box of blue nitrile gloves sitting next to it. Floating within the water bath in the floatation tray, instead of the normal reagents, is a set of a dozen quail eggs. The back of my desk is covered with electronic timers. At the start of dream, I’m wearing a pair of gloves and I have a set of eggs in front of me (in what looks like a standard Waitrose quail egg box). I’m trying to peel the eggs, wearing gloves (I don’t remember having anywhere to discard the shells so don’t know if they are all around me?). I’m finding it really difficult to get enough grip on the eggs; I’m rolling them gently to try and make some cracks appear but I just can’t manage to get a grip on the cracks in the shell in order to get them off cleanly. I’m getting there, but it is taking me ages.
The timer starts going off and I’m trying to get the eggs out of the water bath whilst still having the previous batch on the go. Then the phone rings. I didn’t know who it was. I know there was a discussion about needing them to treat a patient and being asked a bunch of questions that I thought I knew the answers to but not being sure that these eggs were going to do what was needed, despite how important they were. I shove the first lot of eggs into the clear door of the hatch, aware that they need more, and so get on with trying to do the ones that have just come out of the water bath. I’m also looking around as I know I need to get the next batch on. I can’t see any and there’s no time to get any. I change my gloves and start trying to peel the next batch, but they’re still warm and they are hurting my fingers. Not only that, but because they are still hot they are too soft and some of them start to implode as I’m trying to peel. I’ve got yolk all over my gloves and I need to save as many as I can. Then the phone starts ringing and I can’t answer it as I’m covered in yolk and bits of shell. I sit there crying, at my desk, trying to peel the rest, pushing my glasses up with my wrist so I don’t get yolk on my lenses.
The wonderful thing about this process, for me, was that I didn’t see the art being produced. I was on the phone talking to Mark but very specifically not seeing what Julia was producing. I only got to see that at the end and when watching the YouTube video later. I got to be an active part of the creation of a piece of art and that was a wonderful thing. They’ve even now sent me that final piece of art work, which is now going to hang in the on-call bathroom and will be something really concrete for me that has come out of 2020.
It’s a reminder to both take opportunities as they come, and to think about how we can communicate our work in creative and inspiring ways, to reach new audiences, and to work across boundaries.
So, I wanted to take a moment to say a massive thank you to the DreamsID team for including me in this work, and for including me in their article, as this is the one and only time anything linked to me is ever likely to feature in New Scientist! My family finally think I’m a rock star as that’s a science publication they’ve heard of!
girlymicro 