‘In safe hands’
Guernsey’s medical director Dr Peter Rabey has become a familiar face during Covid-19 briefings. Will Green spoke to him about how medical staff have coped during the pandemic and how Covid-19 has reshaped hospital modernisation plans
CALM. Reassuring. Focused.
Qualities that Dr Rabey exudes – medical expertise with a human touch if you like. And it’s this approach that has been at the core of the hospital’s response to the pandemic.
There have also been moments of tragedy, where medical staff held the hands of the dying when family members were unable to, and hope that a brighter future is coming thanks to the efforts of not just medical staff but the whole community.
In the beginning
The interview starts in January 2020. Dr Rabey recalls he was busy doing normal things, such as looking at orthopaedic and rheumatology services.
‘I was really busy,’ he says. People were looking at the virus story, but largely getting on with normal life.
Then things began to change in February, new priorities came in, such as setting up a Covid support phone line and testing centre. From there, Dr Rabey’s ‘busy’ changed to a whole new level and has continued since then.
‘You’re so busy, you never look up. You blink and here we are in March 2021,’ he says.
‘But I’d say the key thing I take from it is that you quickly learn that you’re in really safe hands here. You realise really quickly that from the top of government, they’re not going to let you down. If you need something they’re going to support you. And, right through to the people I work with you find out really quickly that you’re working with a great team.
‘They aren’t glory seekers. They’re people in procurement who are going to do everything they can to get you face masks. In Estates, they’ll do everything they can to make that intensive care work for you by the weekend. The cleaners are going to do extra shifts in in rooms that they know Covid patients have been in before. The nurses are doing the same.
‘And when you’ve got a service where the doctors all had to isolate because they were exposed to it, you’ve just got one left and you just know that they’re going to do 24-seven until the other doctors are able to help.’
Dr Rabey acknowledges people were ‘scared stiff’ because so little was known about Covid-19 at the start. There was worry that deaths could have run into the hundreds, but the community-wide effort helped to limit the pandemic’s worst effects. In the first wave, there were 13 confirmed deaths with another three presumptive deaths.
He reflects that knowledge about the virus, and its effects and treatments, has improved – but that the pandemic has had a very human cost, from deaths to those who have survived but been left with long-term issues as part of what has become colloquially known as ‘Long Covid’ or post-acute Covid-19 syndrome.
The human impact of Covid-19
Dr Rabey, a doctor with many years of experience, has seen deaths before. The difference with this pandemic, he says, is that it was so unexpected and additional to what would normally be seen. Older people suffered particularly during the first wave of the pandemic, with people dying prematurely. ‘Heart-breaking’ is how Dr Rabey puts it, including when the virus entered care homes.
Carers sat with the dying and provided human comfort, so families knew their loved ones didn’t die alone. But as Dr Rabey recognises, to ensure safety for the wider community, it wasn’t the same as those families being together. A video call just isn’t the same. The thought of this brings tears to the interviewer’s eye – for the individuals, families and carers facing such a terrible situation.
‘Compassion just shines through from our end-of-life care teams. Absolutely,’ says the medical director.
He also talks about Long Covid. At the end of the first wave, Public Health undertook a survey of people who had the virus – with two-thirds of respondents reporting that they still had Covid-19-related symptoms. ‘A lot of young people, even without severe disease, are still finding they’re tired, breathless, that sort of thing. It’s another heart-breaking disease when you see it close up.’
Reassuringly, supporting islanders with Long Covid is something that clinical staff are focused on going forward.
Doing whatever it takes
On a personal level, Dr Rabey reflects on how every day has been ‘full on’ – and at times not knowing if it was Monday or Sunday.
‘You just have to do whatever it takes. But it’s good work. Sometimes you’re working in a way that doesn’t feel productive. This has never felt like that, this has felt like you’re making a difference. You’re doing the right thing.’
That also reflects on work done by all of his colleagues.
He also pays tribute to the community, saying the spirit of Guernsey people sticking to the advice and ‘wholeheartedly’ buying into it has enabled the island to get through the pandemic.
Hospital modernisation
One of the spin-off impacts of the pandemic has been a positive evolution of plans for the modernisation of the Princess Elizabeth Hospital. ‘This has happened at a time when we’re designing our new hospital and I’m so glad we hadn’t commissioned our new hospital because it’s going to be completely different because of this,’ explains Dr Rabey.
‘We’ll have an intensive care facility that can care for individual patients who need negative pressure rooms. We’re prioritising the intensive care phase of the new hospital build because if we’d had that, it would have helped us do so much more other work in the hospital – fewer day patient clinics would have been postponed, for example.
‘It’s also made us consider things like oxygen supply for the hospital. You don’t know how much oxygen you might use if you have to cater for 100 people on high flow nasal oxygen. But the new hospital will be able to cope with all that. So hospital design is one very positive thing to come out of this pandemic.’
Resilience of personal protective equipment and drug stocks and supplies is another key consideration. ‘Those weeks when we were down to days’ worth of supply of PPE and just waiting for the next shipment, we can’t ever go back to that. The early days were exceptional, with demand for PPE globally at its highest. It’s calmer now and we now have systems in place to ensure we have at least six months’ supply.’
The hospital now has ‘hot’ and ‘cold’ streams and services to cater, for example, for someone who might be infectious and who needs to be seen somewhere different in A&E to a person who had broken their hip.
The capability of on-island testing is critical, adds the medical director, who also notes that the care home sector has learned lessons from the first wave and become more resilient.
Looking to the future
The conversation ends on an optimistic note of a world where travel is less restricted, with vaccine top-ups from time to time. His colleague Dr Nicola Brink, Public Health director, has been planning for some time the route out of lockdown. Doubtless, Dr Rabey’s expertise has been feeding into that effort as well.
While such decisions are ultimately for the Civil Contingencies Authority, Dr Rabey is optimistic moving towards the summer – if collectively we ‘keep our heads down’ and get on with the situation.
‘You can see a future where travel is less restricted because vaccination has done its job and testing at the airport is all you need to do. You can see a future where we might have to get vaccines every now and again if the virus mutates, but they’ll be quickly available,’ he says.
‘Where people have been vaccinated for Covid in the same way as for flu, and even if they get it, it is hopefully just a flu-like illness and they get on with their life again – and where we know what to do with things like Long Covid and how to rehabilitate people afterwards. The future is really bright.’
