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From Uganda to the UK: Crossing continents for COVID-19 clinical care

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Published: 05 Aug 2020
By Catriona Waitt, Peter Waitt

Sitting by a volcanic crater lake in western Uganda in January 2020, we discussed the potential impact of the recently reported but still unnamed coronavirus, but had no idea of how much change was coming.

Peter-and-Catriona-Photo.jpg

Dr Catriona Waitt and Dr Peter Waitt

5 years ago, we moved to Kampala for Catriona’s Wellcome fellowship. We both work through the Infectious Diseases Institute (IDI), part of Makerere University, which has a vision ’to strengthen health systems in Africa, with a strong emphasis on infectious diseases, through research and capacity development’. Uganda is particularly vulnerable to disease outbreaks; pathogens such as Ebola and Zika were first described in the region, and other notable epidemics include HIV, TB, cholera, and other viral haemorrhagic fevers. The Democratic Republic of Congo border is under 100km from the epicentre of the ongoing and second-largest outbreak of Ebola in history. Strong healthcare systems and a trained workforce are key, and IDI has worked in partnership with the Ministry of Health to build these. We did not anticipate that our experience in Uganda was preparing us for a pandemic affecting the UK.

In keeping with their experience of outbreaks, Uganda mounted an early response to COVID-19. Most research activities were suspended, and social gatherings were banned before the first case was reported. Returning travellers were required to self-isolate for 14 days, and Ugandan citizens were prohibited from flying to ‘high-risk’ areas (including the UK). With much of our work now being done remotely even within Uganda, we felt convinced our skills would be of greater use in the UK. Wellcome contacted all fellows to offer a supportive ‘NHS secondment’ and approved my request within hours, and the University of Liverpool also wrote to offer support for such an arrangement.

Balancing work and family life

Alongside our academic and clinical work, we have both worked-part time for more than a decade (we have children aged 11, 10, 8 and 4, as well as our firstborn who died in 2008). We have lived and worked in five countries, so home education has long been a normal part of our lifestyle. The flexibility is an amazing asset, enabling us to tailor the education of each child and seize the opportunities presented through real life. For example, when Peter works in western Uganda, we can pack up our materials and do lessons sitting by the crater lakes or up a mountain.

The children have spent time with film crews during public engagement activities and volunteered as actors in clinical simulation exercises and enjoy a wide range of social opportunities with children and adults from diverse backgrounds. Our rhythm is that one parent works while the other is home. This does require flexibility and planning, being able to participate in teleconferences from home, and a willingness to work at unusual hours (Catriona’s most productive writing time is pre-dawn), but it works beautifully for our family. Although based in Uganda, we both return to the UK for short periods of time to work as consultant Acute Physicians (Peter on an annualised contract of 10% whole-time equivalent (WTE) and Catriona through a clinical academic job plan).

An accelerated return

We had planned to travel in mid-April, when the UK outbreak reached its ‘peak’ and the workforce was strained. However, one night we heard that air space might be closed within 48 hours, and that we should accelerate our plans. As well as having to find a flight and pack within this short time, we had the additional challenge that our daughter is a Ugandan citizen and her UK visa was not due to start for another week. We were uncertain whether our family could even travel (rumours were circulating about similar families being separated at the airport) and we required emergency written permission from UK border control before the airline would allow us passage. Somewhat miraculously, all of this came together, the airport closure was announced on Saturday evening, and we departed on a final flight the next day.

In Dubai, we caught one of the final flights before that terminal closed too. Thankfully, our children have become accustomed to travelling, changes in plan, and unusual situations, and we have always encouraged them to embrace these as adventures. They loved every moment: particularly sleeping on the floor in Dubai, eating their first ever McDonald’s in the airport and eating nothing but chocolate and biscuits on an 8-hour flight to Manchester (there were no meals, as the catering had already stopped).

So now we are in Liverpool. For the children, that may seem the only real difference. Being home-educated while one parent or other is working, often on a highly infectious pathogen, is ‘normal’ to them, and COVID-19 has perhaps been less disruptive than for many families. We have been frustrated by recent articles and social media discussions stating that childcare responsibilities and successful academic careers are ‘incompatible’; the current situation many families find themselves in is not representative of what can be achieved with careful thought, ongoing discussion of shared priorities and planning, and we strongly believe it is possible to thrive in all areas of life.

Applying lessons from Uganda in the UK

Medically, our time in Uganda was the perfect preparation for our roles here. It is interesting to reflect on how well Uganda has done to advocate clearly for simple, evidence-based interventions that reduce risk. By contrast, the UK has had some gaps, such as a lack of alcohol hand-rub dispensers in public places. Our training in clinical pharmacology and acute medicine provided us with a comprehensive medical grounding that enables adaptation to new situations, so we have been able to hit the ground running.

As many of our colleagues do, we find  discussing escalation of care or end-of-life issues, through personal protective equipment (PPE), with a frightened, alone patient very taxing. This is not how things should be in an ideal world. Perhaps our experience with acutely unwell patients in settings where resources are limited have prepared us for that dissonance. Another aspect that we have brought from outbreak settings in Uganda is the need for psychosocial support or ‘wellbeing’. Healthcare workers need to share their feelings, experiences and fatigue and to build trusting relationships with colleagues to prevent long-term consequences.

Returning to Uganda

We plan to return to Uganda when the UK situation is less intense and travel is possible. Case numbers remain low, but slowly increasing, there and it is possible that on our return we will work clinically, albeit in a very different clinical setting. Although there are many differences in the environment and healthcare system, there are many similarities too, in that societies have been hugely disrupted with potentially the greatest impact being on the most vulnerable. We are thankful that the south–north partnerships we are involved in enable knowledge transfer in both directions, with the ultimate, shared aim being the prevention of suffering.

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Published: 05 Aug 2020
By Catriona Waitt, Peter Waitt

About the author

Catriona Waitt

Catriona Waitt (@CatrionaWaitt) is a Reader in Clinical Pharmacology at the University of Liverpool, a Wellcome clinical postdoctoral fellow based at the Infectious Diseases Institute, Makerere University College of Health Sciences, and an honorary Consultant in Acute Medicine at the Liverpool University Hospitals NHS Foundation Trust. Her research theme surrounds drug dosing and safety in pregnancy and breastfeeding, and other ‘difficult to study’ populations. This includes clinical trials and observational studies with an emphasis on pharmacometrics to maximise efficient study design and interpretation of data, together with engagement activities at stakeholder and community level.

Peter Waitt

Peter Waitt (@AcutePete) is an Acute Physician at Wirral University Hospitals NHS Foundation Trust and the Infectious Disease Institute as Uganda Clinical Lead on the Joint Mobile Emerging Disease Clinical Capability Project, supporting the building of research and clinical capacity to respond to highly infectious pathogens, including Ebola and other viral haemorrhagic fevers.

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